Provider Demographics
NPI:1396862165
Name:FOUNDATION FOR ARIZONA'S YOUTH, LLC
Entity Type:Organization
Organization Name:FOUNDATION FOR ARIZONA'S YOUTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-723-1626
Mailing Address - Street 1:1404 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:COOLIDGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85228-4146
Mailing Address - Country:US
Mailing Address - Phone:520-723-1626
Mailing Address - Fax:
Practice Address - Street 1:1404 S 7TH ST
Practice Address - Street 2:
Practice Address - City:COOLIDGE
Practice Address - State:AZ
Practice Address - Zip Code:85228-4146
Practice Address - Country:US
Practice Address - Phone:520-723-1626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-24
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-2854322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children