Organization
GENREV FAMILY RESOURCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARNELL COLBERT (CEO)
(602) 505-2683
Entity
Organization
Contact information
Practice address
8537 W WILSHIRE DR, PHOENIX, AZ 85037-3710
(602) 505-2683
Mailing address
2512 E THOMAS RD STE 9, PHOENIX, AZ 85016-7937
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
BH4495
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH4495
MERCY CARE
AZ
Enumeration date
01/07/2015
Last updated
01/09/2015
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