Healthcare Provider Details

I. General information

NPI: 1508071861
Provider Name (Legal Business Name): PINAL GILA COMMUNITY CHILD SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N PLAZA DR
APACHE JUNCTION AZ
85220-4110
US

IV. Provider business mailing address

1750 S ARIZONA BLVD
COOLIDGE AZ
85228-5920
US

V. Phone/Fax

Practice location:
  • Phone: 480-982-4516
  • Fax: 480-288-9501
Mailing address:
  • Phone: 520-723-1213
  • Fax: 520-723-0806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number StateAZ

VIII. Authorized Official

Name: MS. SUSAN LUICCI-DAVIS
Title or Position: ACCOUNTING SPECIALIST
Credential:
Phone: 520-723-1213