Provider Demographics
NPI:1821204652
Name:YUMA CHILDRENS REHABILITATIVE SERVICES MEDICAL GROUP LTD
Entity Type:Organization
Organization Name:YUMA CHILDRENS REHABILITATIVE SERVICES MEDICAL GROUP LTD
Other - Org Name:CHILDREN'S HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS OPERATIONS SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-336-7362
Mailing Address - Street 1:2400 S AVENUE A
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2400 S AVENUE A
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7127
Practice Address - Country:US
Practice Address - Phone:928-336-7362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty