Organization
CHICANOS POR LA CAUSA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PEDRO CONS (EXECUTIVE VICE PRESIDENT)
(602) 257-0700
Entity
Organization
Contact information
Practice address
3639 W LINCOLN ST, PHOENIX, AZ 85009-5516
(602) 233-9747
Mailing address
1112 E BUCKEYE RD, PHOENIX, AZ 85034-4043
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
590978
—
AZ
01
—
BH-008
STATE LICENSE
AZ
Enumeration date
05/29/2019
Last updated
05/29/2019
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