Provider Demographics
NPI:1407957467
Name:ARIZONA BAPTIST CHILDREN'S SERVICES
Entity Type:Organization
Organization Name:ARIZONA BAPTIST CHILDREN'S SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:602-346-2319
Mailing Address - Street 1:PO BOX 35637
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85069-5637
Mailing Address - Country:US
Mailing Address - Phone:602-346-2300
Mailing Address - Fax:602-346-2399
Practice Address - Street 1:1717 W NORTHERN AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-5469
Practice Address - Country:US
Practice Address - Phone:602-346-2300
Practice Address - Fax:602-346-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH2681322D00000X
AZBH2784322D00000X
AZBH1340322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ044678OtherAHCCCS PROVIDER ID NO
AZ011411OtherAHCCCS PROVIDER ID NO.
AZ1020012OtherADHS PROVIDER ID NO
AZ117284OtherAHCCCS PROVIDER ID NO.
AZ1020005OtherADHS PROVIDER ID NO.
AZ1020010OtherADHS PROVIDER ID NO.