Organization
CHICANOS POR LA CAUSA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDMUNDO HIDALGO (CEO)
(602) 257-0700
Entity
Organization
Contact information
Practice address
1402 SOUTH CENTRAL AVE, PHOENIX, AZ 85000-2801
(602) 257-0700
Mailing address
1112 E BUCKEYE RD, PHOENIX, AZ 85034-4043
(602) 257-0700
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
BH4031
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112219
—
AZ
Enumeration date
08/09/2012
Last updated
10/10/2012
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