| Cbi Winslow Juvenile Detention Program | |
|
110 E Second St Winslow AZ 86047-3704 | |
| (928) 289-1122 | |
| Not Available |
| Full Name | Cbi Winslow Juvenile Detention Program |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 110 E Second St, Winslow, Arizona |
| Authorized Official Name and Position | John Hogeboom (PRESIDENT/CEO) |
| Authorized Official Contact | 4808317566 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cbi Winslow Juvenile Detention Program 1855 W Baseline Rd Ste 101 Mesa AZ 85202-9098 Ph: (480) 831-7566 | Cbi Winslow Juvenile Detention Program 110 E Second St Winslow AZ 86047-3704 Ph: (928) 289-1122 |
| NPI Number | 1780333799 |
|---|---|
| Provider Enumeration Date | 03/18/2022 |
| Last Update Date | 07/14/2022 |
| Certification Date | 07/14/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780333799 | NPI | - | NPPES |
| BH6949 | Other | AZ | ADHS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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