Healthcare Provider Details

I. General information

NPI: 1972437614
Provider Name (Legal Business Name): FAMILY SUPPORT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16601 N 75TH AVE UNIT 2084
PEORIA AZ
85382-5047
US

IV. Provider business mailing address

16601 N 75TH AVE UNIT 2084
PEORIA AZ
85382-5047
US

V. Phone/Fax

Practice location:
  • Phone: 480-799-9484
  • Fax: 480-799-9484
Mailing address:
  • Phone: 480-799-9484
  • Fax: 480-799-9484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: GENEVEE HALL
Title or Position: MANAGER
Credential:
Phone: 480-799-9484