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Organization
ARIZONA BAPTIST CHILDREN'S SERVICES
Active
Organization
ARIZONA BAPTIST CHILDREN'S SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DON E. MCDANIEL JR. (SENIOR VICE PRESIDENT)
(602) 346-2319
Entity
Organization
Contact information
Practice address
1717 W NORTHERN AVE, PHOENIX, AZ 85021-5469
(602) 346-2300
(602) 346-2399
Mailing address
PO BOX 35637, PHOENIX, AZ 85069-5637
(602) 346-2300
(602) 346-2399
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
BH1340
AZ
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
BH2681
AZ
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
BH2784
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011411
AHCCCS PROVIDER ID NO.
AZ
01
—
044678
AHCCCS PROVIDER ID NO
AZ
01
—
1020005
ADHS PROVIDER ID NO.
AZ
01
—
1020010
ADHS PROVIDER ID NO.
AZ
01
—
1020012
ADHS PROVIDER ID NO
AZ
01
—
117284
AHCCCS PROVIDER ID NO.
AZ
Enumeration date
09/25/2006
Last updated
08/22/2020
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