Healthcare Provider Details

I. General information

NPI: 1710716758
Provider Name (Legal Business Name): FAMILY SERVICE AIDES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/29/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W INDIAN SCHOOL RD
PHOENIX AZ
85013-3203
US

IV. Provider business mailing address

201 W INDIAN SCHOOL RD
PHOENIX AZ
85013-3203
US

V. Phone/Fax

Practice location:
  • Phone: 602-795-1170
  • Fax:
Mailing address:
  • Phone: 602-795-1170
  • Fax:

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 Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE MARIE CERNIGLIA
Title or Position: CEO
Credential:
Phone: 602-509-8296