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
1107 S GILBERT RD, SUITE 104, MESA, AZ 85204-5232
(602) 264-9891
(602) 234-2639
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-1277
AZ
251V00000X
Voluntary or Charitable Agency
OTC8084
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
117079
AHCCCS
AZ
01
—
OTC11459
ADHS/BMFL
AZ
Enumeration date
06/28/2007
Last updated
11/21/2023
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