MEDICARE: FAMILY SUPPORT CARE

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	BH-3567	AZ

General Provider Information

NPI Number	:	1386958239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY SUPPORT CARE

Provider Business Mailing Address
First Line	:	1209 W BOSTON ST
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-6168
Country	:	US
Telephone Number	:	614-286-8511
Fax Number	:	614-416-2091

Provider Business Practice Location Address
First Line	:	1209 W BOSTON ST
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-6168
Country	:	US
Telephone Number	:	614-286-8511
Fax Number	:	614-416-2091

Authorized Official
Title or Position	:	MD
Name	:	KINGSLEY S OKYERE
Credential	:
Telephone Number	:	614-286-8511

Provider Enumeration Date	:	08/03/2010
Last Update Date	:	08/03/2010

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Directions to “FAMILY SUPPORT CARE ” Practice Location

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