Healthcare Provider Details

I. General information

NPI: 1154471175
Provider Name (Legal Business Name): NEW ARIZONA FAMILY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 N 25TH PL
PHOENIX AZ
85008-2774
US

IV. Provider business mailing address

4222 E THOMAS RD SUITE 150
PHOENIX AZ
85018-7607
US

V. Phone/Fax

Practice location:
  • Phone: 602-553-7300
  • Fax: 602-553-7303
Mailing address:
  • Phone: 602-553-7300
  • Fax: 602-553-7303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License NumberBH 2797
License Number StateAZ

VIII. Authorized Official

Name: MR. THOMAS K MCKELVEY
Title or Position: CEO
Credential:
Phone: 602-553-7300