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1701 North Douglasave Douglas AZ 85607 | |
| (520) 727-7091 | |
| (520) 364-2770 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1701 North Douglasave, Douglas, Arizona |
| Authorized Official Name and Position | Fred R Cogburn (CEO) |
| Authorized Official Contact | 9283760026 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2851 S Ave B Bldg 4 Yuma AZ 85364 Ph: (928) 376-0026 | 1701 North Douglasave Douglas AZ 85607 Ph: (520) 727-7091 |
| NPI Number | 1245523364 |
|---|---|
| Provider Enumeration Date | 05/23/2011 |
| Last Update Date | 02/10/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245523364 | NPI | - | NPPES |
| 881988 | Medicaid | AZ | |
| 620627 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | BH-3221 (Arizona) | Primary |
| 251S00000X | Community/behavioral Health | BH-3769 (Arizona) | Secondary |
Cypress Inn Assisted Living Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 757 E 12th St, Douglas, AZ 85607 Phone: 520-364-7232 Fax: 520-364-5322 | |
Caring Connections For Special Needs, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1019 F Ave, Douglas, AZ 85607 Phone: 520-364-3162 | |
Child & Family Resources, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 855 Cochise Ave, Douglas, AZ 85607 Phone: 520-364-5150 Fax: 520-364-5703 | |