Provider Demographics
NPI:1225414881
Name:CHILD CRISIS ARIZONA
Entity Type:Organization
Organization Name:CHILD CRISIS ARIZONA
Other - Org Name:CHILD CRISIS CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SENIOR ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SILAJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-304-4320
Mailing Address - Street 1:817 NORTH COUNTRY CLUB DRIVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201
Mailing Address - Country:US
Mailing Address - Phone:480-834-9424
Mailing Address - Fax:
Practice Address - Street 1:170 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-5836
Practice Address - Country:US
Practice Address - Phone:480-834-9424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-06
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
AZCSLG 7172251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty