Organization
COMMUNITY INTERVENTION ASSOCIATES
Active
Other names
Community Health Associates
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FRED R COGBURN (CEO)
(928) 376-0026
Entity
Organization
Contact information
Practice address
1938 E JUAN SANCHEZ BLVD, SUITE 4, SAN LUIS, AZ 85349
(928) 376-0026
(928) 782-2298
Mailing address
2851 S AVE B, BLDG 4, YUMA, AZ 85364
(928) 376-0026
(928) 782-2298
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
BH-3479
AZ
251S00000X
Community/Behavioral Health Agency
BH3479
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
496988
—
AZ
05
—
849596
—
AZ
Enumeration date
02/16/2010
Last updated
02/10/2016
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