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?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)