# YOUTH DEVELOPMENT INSTITUTE

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

## Provider details

- **NPI number:** 1508939554
- **Authorized official:** TRISH COCOROS (ASSOCIATE DIRECTOR)
- **Authorized official phone:** (602) 254-0884

## Contact information

- **Practice address:** 1050 N 19TH ST, BLDG. A, PHOENIX, AZ 85006-3679
- **Practice address phone:** (602) 254-0884
- **Mailing address:** 1830 E ROOSEVELT ST, PHOENIX, AZ 85006-3641

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | BH-311 | AZ | Yes |

## Other

- **Enumeration date:** 11/16/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 455213 | AHCCCS PROVIDER \# | AZ |