Organization
FAMILY SERVICE AGENCY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSE M LOPEZ MBA (PRESIDENT AND CEO)
(520) 721-1887
Entity
Organization
Contact information
Practice address
10220 N 31ST AVE STE 103-105, PHOENIX, AZ 85051-9581
(602) 863-1862
(602) 863-4388
Mailing address
PO BOX 86537, TUCSON, AZ 85754-6537
(520) 721-1887
(520) 721-0069
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
251V00000X
Voluntary or Charitable Agency
BH-383
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
117178
AHCCCS
AZ
01
—
BH4241-OTC8910
ADHS/BMFL
AZ
Enumeration date
06/28/2007
Last updated
11/21/2023
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