| Chicanos Por La Causa Inc | |
|
1402 South Central Ave Phoenix AZ 85000-2801 | |
| (602) 257-0700 | |
| Not Available |
| Full Name | Chicanos Por La Causa Inc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1402 South Central Ave, Phoenix, Arizona |
| Authorized Official Name and Position | Edmundo Hidalgo (CEO) |
| Authorized Official Contact | 6022570700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Chicanos Por La Causa Inc 1112 E Buckeye Rd Phoenix AZ 85034-4043 Ph: (602) 257-0700 | Chicanos Por La Causa Inc 1402 South Central Ave Phoenix AZ 85000-2801 Ph: (602) 257-0700 |
| NPI Number | 1104173046 |
|---|---|
| Provider Enumeration Date | 08/09/2012 |
| Last Update Date | 10/10/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104173046 | NPI | - | NPPES |
| 112219 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | BH4031 (Arizona) | Primary |
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