Healthcare Provider Details

I. General information

NPI: 1578629481
Provider Name (Legal Business Name): FSL PROGRAMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9555 W VAN BUREN ST
TOLLESON AZ
85353-2816
US

IV. Provider business mailing address

1201 E THOMAS RD
PHOENIX AZ
85014-5734
US

V. Phone/Fax

Practice location:
  • Phone: 623-932-1104
  • Fax: 623-923-1132
Mailing address:
  • Phone: 602-285-1800
  • Fax: 602-285-1838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberADHC-1919
License Number StateAZ

VIII. Authorized Official

Name: MS. ANNETTE INIGUEZ
Title or Position: EXEC ASST
Credential:
Phone: 602-285-0505