Provider Demographics
NPI:1194269415
Name:HUMANITAS FAMILY CENTER LLC
Entity type:Organization
Organization Name:HUMANITAS FAMILY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ MURILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-909-8741
Mailing Address - Street 1:308 N MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-2746
Mailing Address - Country:US
Mailing Address - Phone:888-909-8741
Mailing Address - Fax:805-640-7844
Practice Address - Street 1:701 W GROVE PKWY
Practice Address - Street 2:#164
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-4501
Practice Address - Country:US
Practice Address - Phone:888-909-8741
Practice Address - Fax:805-640-7844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1-10-6815103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1-10-6815OtherBCBA