Provider Demographics
NPI:1255437836
Name:CATHOLIC COMMUNITY SERVICES IN WESTERN AZ
Entity type:Organization
Organization Name:CATHOLIC COMMUNITY SERVICES IN WESTERN AZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEZ-COUNTS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:928-341-9400
Mailing Address - Street 1:690 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-3437
Mailing Address - Country:US
Mailing Address - Phone:928-341-9400
Mailing Address - Fax:
Practice Address - Street 1:690 E 32ND ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-3437
Practice Address - Country:US
Practice Address - Phone:928-341-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL3382D261QA0600X
332U00000X
AZOTC6081101YM0800X, 101YA0400X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Multi-Specialty
No332U00000XSuppliersHome Delivered MealsGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ062125Medicaid