Provider Demographics
NPI:1386958239
Name:FAMILY SUPPORT CARE
Entity type:Organization
Organization Name:FAMILY SUPPORT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:KINGSLEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:OKYERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-286-8511
Mailing Address - Street 1:1209 W BOSTON ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6168
Mailing Address - Country:US
Mailing Address - Phone:614-286-8511
Mailing Address - Fax:614-416-2091
Practice Address - Street 1:1209 W BOSTON ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6168
Practice Address - Country:US
Practice Address - Phone:614-286-8511
Practice Address - Fax:614-416-2091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-3567320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities