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General NPI Number Information
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NPI Number | 1710455860
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Entity Type | Organization
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Legal Business Name | COMMUNITY INTERVENTION ASSOCIATES, INC
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Dates
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Enumeration Date | 11/07/2018
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Last Update Date | 11/07/2018
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Provider Practice Location Address
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Address Line | 1667 N. TREKELL RD SUITE 101 & 102
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City | CASA GRANDE
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State | AZ
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Zip | 85122
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Country | US
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Telephone | 520-284-7782
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Fax | 520-836-5436
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Provider Business Mailing Address
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Address Line | 2851 S AVE B BLDG #4
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City | YUMA
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State | AZ
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Zip | 85364
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Country | US
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Telephone | 520-988-0811
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Fax | 928-782-2298
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Authorized Official
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Title or Position | OWNER
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Name | ALISSE ALVAREZ
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Credential |
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Telephone | 928-376-0026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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