Provider Demographics
NPI:1487078275
Name:CHRISTIAN FAMILY CARE
Entity type:Organization
Organization Name:CHRISTIAN FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL FOSTER CARE
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-986-1812
Mailing Address - Street 1:3603 N 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3638
Mailing Address - Country:US
Mailing Address - Phone:602-234-1935
Mailing Address - Fax:602-234-0022
Practice Address - Street 1:14418 W CAMERON DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-4420
Practice Address - Country:US
Practice Address - Phone:623-986-1812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1514251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ529612Medicaid