Healthcare Provider Details

I. General information

NPI: 1558691824
Provider Name (Legal Business Name): INTEGRATED FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2010
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1684 W MACAW DR
CHANDLER AZ
85286-7449
US

IV. Provider business mailing address

1684 W MACAW DR
CHANDLER AZ
85286-7449
US

V. Phone/Fax

Practice location:
  • Phone: 480-294-2056
  • Fax:
Mailing address:
  • Phone: 480-294-2056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateAZ

VIII. Authorized Official

Name: CATHERINE CAMILLE ORSAK
Title or Position: PRESIDENT
Credential:
Phone: 480-294-2056