Provider Demographics
NPI:1316785538
Name:FAMOS CARE
Entity type:Organization
Organization Name:FAMOS CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:KABUKURU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-384-2001
Mailing Address - Street 1:4633 W VALENCIA DR
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2366
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4633 W VALENCIA DR
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-2366
Practice Address - Country:US
Practice Address - Phone:818-384-2001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMOS CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-20
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health