Provider Demographics
NPI:1447508403
Name:FRIENDSHIP COMMUNITY MENTAL HEALTH CENTER
Entity type:Organization
Organization Name:FRIENDSHIP COMMUNITY MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:LISAC
Authorized Official - Phone:602-241-6656
Mailing Address - Street 1:730 E HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-3625
Mailing Address - Country:US
Mailing Address - Phone:602-241-6656
Mailing Address - Fax:
Practice Address - Street 1:730 E HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-3625
Practice Address - Country:US
Practice Address - Phone:602-241-6656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLISAC 10387OtherBEHAVIORAL HEALTH