Organization
YOUTH DEVELOPMENT INSTITUTE
Active
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
1830 E ROOSEVELT ST, PHOENIX, AZ 85006-3641
(602) 254-0884
Mailing address
1830 E ROOSEVELT ST, PHOENIX, AZ 85006-3641
(602) 254-0884
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
BH-159
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
455263
AHCCCS PROVIDER #
AZ
Enumeration date
11/20/2006
Last updated
08/22/2020
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