Provider Demographics
NPI:1417033630
Name:YUMA TREATMENT CENTER LLC
Entity Type:Organization
Organization Name:YUMA TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-996-0105
Mailing Address - Street 1:19401 N CAVE CREEK ROAD
Mailing Address - Street 2:#18 ADMINISTRATIVE OFFICE
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-1825
Mailing Address - Country:US
Mailing Address - Phone:602-996-0105
Mailing Address - Fax:602-996-1915
Practice Address - Street 1:1290 W 8TH PLACE
Practice Address - Street 2:YUMA TREATMENT CENTER
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364
Practice Address - Country:US
Practice Address - Phone:928-344-4310
Practice Address - Fax:928-344-4366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH2472251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ10066MOtherFDA
AZ872128OtherAHCCCS
AZ872128OtherAHCCCS