Provider Demographics
NPI:1710552500
Name:IYA INDEPENDENT YOUTH ADVOCATES
Entity Type:Organization
Organization Name:IYA INDEPENDENT YOUTH ADVOCATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-334-8075
Mailing Address - Street 1:1321 W PARK ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-7019
Mailing Address - Country:US
Mailing Address - Phone:480-334-8075
Mailing Address - Fax:
Practice Address - Street 1:14245 S 48TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6470
Practice Address - Country:US
Practice Address - Phone:480-334-8075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management