Healthcare Provider Details

I. General information

NPI: 1497267892
Provider Name (Legal Business Name): CATHOLIC COMMUNITY SERVICES YUMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 S 15TH AVE
YUMA AZ
85364-1939
US

IV. Provider business mailing address

690 E 32ND ST
YUMA AZ
85365-3437
US

V. Phone/Fax

Practice location:
  • Phone: 928-783-8316
  • Fax: 928-783-8317
Mailing address:
  • Phone: 928-340-9400
  • Fax: 928-726-4400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberAL3382D
License Number StateAZ

VIII. Authorized Official

Name: EVA JASSO MENDEZ-COUNTS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 928-341-9400