Healthcare Provider Details

I. General information

NPI: 1255437836
Provider Name (Legal Business Name): CATHOLIC COMMUNITY SERVICES IN WESTERN AZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 E 32ND ST
YUMA AZ
85365-3437
US

IV. Provider business mailing address

690 E 32ND ST
YUMA AZ
85365-3437
US

V. Phone/Fax

Practice location:
  • Phone: 928-341-9400
  • Fax:
Mailing address:
  • Phone: 928-341-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberAL3382D
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberOTC6081
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberOTC6081
License Number StateAZ
# 5
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberOTC6081
License Number StateAZ

VIII. Authorized Official

Name: MRS. EVA MENDEZ-COUNTS
Title or Position: EXECUTIVE DIRECTOR
Credential: M.A.
Phone: 928-341-9400