Organization
YOUTH DEVELOPMENT INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRISH COCOROS (ASSOCIATE DIRECTOR)
(602) 254-0884
Entity
Organization
Contact information
Practice address
1050 N 19TH ST, BLDG. A, PHOENIX, AZ 85006-3679
(602) 254-0884
Mailing address
1830 E ROOSEVELT ST, PHOENIX, AZ 85006-3641
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
BH-311
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
455213
AHCCCS PROVIDER #
AZ
Enumeration date
11/16/2006
Last updated
08/22/2020
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