Provider Demographics
NPI:1366884413
Name:FAMILY INVOLVEMENT CENTER, INC
Entity type:Organization
Organization Name:FAMILY INVOLVEMENT CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KALLAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-412-4070
Mailing Address - Street 1:5333 N 7TH ST STE A130
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2821
Mailing Address - Country:US
Mailing Address - Phone:602-412-4070
Mailing Address - Fax:602-288-0156
Practice Address - Street 1:8766 E STATE ROUTE 69 STE G
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-8975
Practice Address - Country:US
Practice Address - Phone:928-713-3248
Practice Address - Fax:928-458-5914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4329251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management