MEDICARE: FLORENCE CRITTENTON SERVICES OF ARIZONA, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	BH-2133	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326217308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORENCE CRITTENTON SERVICES OF ARIZONA, INC.

Provider Business Mailing Address
First Line	:	715 W MARIPOSA ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-2449
Country	:	US
Telephone Number	:	602-274-7318
Fax Number	:	602-274-7549

Provider Business Practice Location Address
First Line	:	715 W MARIPOSA ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-2449
Country	:	US
Telephone Number	:	602-274-7318
Fax Number	:	602-274-7549

Authorized Official
Title or Position	:	CEO
Name	:	KELLIE M. WARREN
Credential	:	PSY.D.
Telephone Number	:	602-274-7318

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	04/28/2014

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