Provider Demographics
NPI:1841958717
Name:BRANCHING OUT FAMILY SERVICES
Entity type:Organization
Organization Name:BRANCHING OUT FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HURTWICKER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:480-757-1002
Mailing Address - Street 1:1820 E RAY RD STE A204
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-8720
Mailing Address - Country:US
Mailing Address - Phone:480-757-1002
Mailing Address - Fax:
Practice Address - Street 1:1820 E RAY RD STE A204
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-8720
Practice Address - Country:US
Practice Address - Phone:480-757-1002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ468764Medicaid