# YOUTH DEVELOPMENT INSTITUTE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336305176
- **Authorized official:** TRISH COCOROS (ASSOCIATE DIRECTOR)
- **Authorized official phone:** (602) 256-5311

## Contact information

- **Practice address:** 1921 EAST PORTLAND STREET, PHOENIX, AZ 85006
- **Practice address phone:** (602) 256-5300
- **Mailing address:** 1830 E ROOSEVELT ST, PHOENIX, AZ 85006-3641
- **Mailing address phone:** (602) 256-5300

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | BH-3061 | AZ | Yes |

## Other

- **Enumeration date:** 07/31/2008
- **Last updated:** 07/31/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | BH-3061 | OBHL | AZ |