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Organization
YOUTH DEVELOPMENT INSTITUTE
Active
Organization
YOUTH DEVELOPMENT INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRISH COCOROS (ASSOCIATE DIRECTOR)
(602) 256-5311
Entity
Organization
Contact information
Practice address
1927 EAST PORTLAND STREET, PHOENIX, AZ 85006
(602) 256-5300
Mailing address
1830 E ROOSEVELT ST, PHOENIX, AZ 85006-3641
(602) 256-5300
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
BH-3760
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
581158
AHCCCS
AZ
01
—
BH-3760
OBHL
AZ
Enumeration date
07/31/2008
Last updated
02/15/2011
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