Provider Demographics
NPI:1407985617
Name:CHILD & FAMILY SERVICES OF YUMA, INC.
Entity Type:Organization
Organization Name:CHILD & FAMILY SERVICES OF YUMA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-783-0141
Mailing Address - Street 1:301 S 2ND AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-2248
Mailing Address - Country:US
Mailing Address - Phone:928-783-0141
Mailing Address - Fax:928-783-0179
Practice Address - Street 1:257 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-2359
Practice Address - Country:US
Practice Address - Phone:928-783-2427
Practice Address - Fax:928-783-0633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-505322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ145062Medicaid