MEDICARE: FUTURE OPTIONS OF ARIZONA

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1720613466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FUTURE OPTIONS OF ARIZONA

Provider Business Mailing Address
First Line	:	3101 N CENTRAL AVE # 220
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2645
Country	:	US
Telephone Number	:	480-270-4373
Fax Number	:

Provider Business Practice Location Address
First Line	:	3101 N CENTRAL AVE # 220
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2645
Country	:	US
Telephone Number	:	480-270-4373
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LOREN BROUSSARD
Credential	:
Telephone Number	:	480-580-2946

Provider Enumeration Date	:	03/03/2020
Last Update Date	:	03/03/2020

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