Organization
COMMUNITY INTERVENTION ASSOCIATES, INC.
Active
Parent organization
COMMUNITY INTERVENTION ASSOCIATES, INC.
Other names
Community Intervention Associates
Organization subpart
Yes
Provider details
NPI number
Legal business name
COMMUNITY INTERVENTION ASSOCIATES, INC.
Authorized official
MR. FRED R COGBURN (CEO)
(928) 376-0026
Entity
Organization
Contact information
Practice address
1326 HWY 92, SUITE J, BISBEE, AZ 85603-0000
(520) 366-3603
(520) 432-3678
Mailing address
2851 S AVENUE B, BLDG 4, YUMA, AZ 85364-7726
(928) 376-0026
(928) 782-2298
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
BH-3770
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
620609
—
AZ
Enumeration date
05/23/2011
Last updated
08/28/2013
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