Provider Demographics
NPI:1497267892
Name:CATHOLIC COMMUNITY SERVICES YUMA
Entity Type:Organization
Organization Name:CATHOLIC COMMUNITY SERVICES YUMA
Other - Org Name:DAYBREAK ADULT DAY HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:JASSO
Authorized Official - Last Name:MENDEZ-COUNTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-341-9400
Mailing Address - Street 1:690 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-3437
Mailing Address - Country:US
Mailing Address - Phone:928-340-9400
Mailing Address - Fax:928-726-4400
Practice Address - Street 1:321 S 15TH AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-1939
Practice Address - Country:US
Practice Address - Phone:928-783-8316
Practice Address - Fax:928-783-8317
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC COMMUNITY SERVICES OF SOUTHERN ARIZONA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL3382D261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ153841Medicaid