Provider Demographics
NPI: | 1629544788 |
---|---|
Name: | CHICANOS POR LA CAUSA, INC. |
Entity Type: | Organization |
Organization Name: | CHICANOS POR LA CAUSA, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE VICE PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ANDRES |
Authorized Official - Middle Name: | L |
Authorized Official - Last Name: | CONTRERAS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 602-282-8501 |
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: | |
Practice Address - Street 1: | 6850 W INDIAN SCHOOL RD |
Practice Address - Street 2: | |
Practice Address - City: | PHOENIX |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85033-3249 |
Practice Address - Country: | US |
Practice Address - Phone: | 623-247-0464 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | CHICANOS POR LA CAUSA, INC. |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2018-10-16 |
Last Update Date: | 2023-08-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |