Provider Demographics
NPI:1487126686
Name:FJCM BEHAVIORAL HEALTH CARE LLC
Entity type:Organization
Organization Name:FJCM BEHAVIORAL HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FAUSTIN
Authorized Official - Middle Name:BULONGO
Authorized Official - Last Name:KAPELEMBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-643-5723
Mailing Address - Street 1:4730 W SAMANTHA WAY
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2141
Mailing Address - Country:US
Mailing Address - Phone:602-643-5723
Mailing Address - Fax:602-281-6742
Practice Address - Street 1:2710 E VALENCIA DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-7081
Practice Address - Country:US
Practice Address - Phone:602-643-5723
Practice Address - Fax:602-281-6742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility