Provider Demographics
NPI:1487024543
Name:CHICANOS POR LA CAUSA, INC
Entity Type:Organization
Organization Name:CHICANOS POR LA CAUSA, INC
Other - Org Name:CENTRO ESPERANZA
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTRERAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-254-4827
Mailing Address - Street 1:1112 E BUCKEYE RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-4043
Mailing Address - Country:US
Mailing Address - Phone:602-257-0700
Mailing Address - Fax:602-256-2740
Practice Address - Street 1:325 N STAPLEY DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203
Practice Address - Country:US
Practice Address - Phone:480-615-3800
Practice Address - Fax:480-834-3536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-01
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC7328251S00000X
AZBH3365251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health