Healthcare Provider Details

I. General information

NPI: 1295190197
Provider Name (Legal Business Name): P & C FAMILY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2015
Last Update Date: 12/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 N CENTRAL AVE STE 1400
PHOENIX AZ
85004-4436
US

IV. Provider business mailing address

40 N CENTRAL AVE STE 1400
PHOENIX AZ
85004-4436
US

V. Phone/Fax

Practice location:
  • Phone: 702-754-3484
  • Fax: 702-629-7952
Mailing address:
  • Phone: 702-754-3484
  • Fax: 702-629-7952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CLEVONNE FUNCHES
Title or Position: DIRECTOR
Credential:
Phone: 702-754-3484