Provider Demographics
NPI:1003059585
Name:COMMUNITY ALLIANCE FOR YOUTH AND FAMILLY SERVICES
Entity type:Organization
Organization Name:COMMUNITY ALLIANCE FOR YOUTH AND FAMILLY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERMAINE
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:FORT
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:480-703-4143
Mailing Address - Street 1:23568 N OASIS BLVD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85232-8068
Mailing Address - Country:US
Mailing Address - Phone:520-723-1337
Mailing Address - Fax:
Practice Address - Street 1:23568 N OASIS BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85232-8068
Practice Address - Country:US
Practice Address - Phone:520-723-1337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3179322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children