Provider Demographics
NPI:1396520011
Name:FAMILY HOME LLC
Entity type:Organization
Organization Name:FAMILY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOJOK
Authorized Official - Middle Name:
Authorized Official - Last Name:AJAWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-358-7850
Mailing Address - Street 1:6035 W KRISTAL WAY
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7802
Mailing Address - Country:US
Mailing Address - Phone:480-358-7850
Mailing Address - Fax:
Practice Address - Street 1:10423 W EDGEMONT DR
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-4652
Practice Address - Country:US
Practice Address - Phone:480-358-7850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities