Provider Demographics
NPI:1194223941
Name:COMMUNITY INTERVENTION ASSOCIATES, INC
Entity Type:Organization
Organization Name:COMMUNITY INTERVENTION ASSOCIATES, INC
Other - Org Name:COMMUNITY HEALTH ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:COSBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-376-0026
Mailing Address - Street 1:2851 S. AVE B
Mailing Address - Street 2:BLDG #4
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364
Mailing Address - Country:US
Mailing Address - Phone:928-376-0026
Mailing Address - Fax:928-782-2298
Practice Address - Street 1:410 S. MAIDEN LANE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364
Practice Address - Country:US
Practice Address - Phone:928-376-0026
Practice Address - Fax:928-782-2298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No251S00000XAgenciesCommunity/Behavioral Health