Provider Demographics
NPI:1801545850
Name:AZ FAMILIES CO-OP LLC
Entity type:Organization
Organization Name:AZ FAMILIES CO-OP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:REX
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-755-2932
Mailing Address - Street 1:5425 E BROADWAY BLVD # 286
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3704
Mailing Address - Country:US
Mailing Address - Phone:855-755-2932
Mailing Address - Fax:855-755-2932
Practice Address - Street 1:4391 EAST MARSHALL CT
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297
Practice Address - Country:US
Practice Address - Phone:855-755-2932
Practice Address - Fax:855-755-2932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ429547OtherAHCCCS NUMBER
AZQ07201813808OtherDIVISION OF DEVELOPMENTAL DISABILITIES DDD