Provider Demographics
NPI:1508071861
Name:PINAL GILA COMMUNITY CHILD SERVICES
Entity Type:Organization
Organization Name:PINAL GILA COMMUNITY CHILD SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUICCI-DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-723-1213
Mailing Address - Street 1:1750 S ARIZONA BLVD
Mailing Address - Street 2:
Mailing Address - City:COOLIDGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85228-5920
Mailing Address - Country:US
Mailing Address - Phone:520-723-1213
Mailing Address - Fax:520-723-0806
Practice Address - Street 1:900 N PLAZA DR
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85220-4110
Practice Address - Country:US
Practice Address - Phone:480-982-4516
Practice Address - Fax:480-288-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ225100000X, 225X00000X, 2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty