YOUTH DEVELOPMENT INSTITUTE NPI 1508939554

NPI Information

NPI: 1508939554
Provider Name: YOUTH DEVELOPMENT INSTITUTE
Classification: Residential Treatment Facility, Emotionally Disturbed Children - 322D00000X
Entity Type: Organization

CLIA Number: 03D0969083

Address:
1050 N 19TH ST
BLDG. A
PHOENIX, AZ
ZIP 85006
Phone: (602) 254-0884
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YOUTH DEVELOPMENT INSTITUTE is a residential treatment facility emotionally disturbed children in Phoenix, AZ. The provider is a residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently. YOUTH DEVELOPMENT INSTITUTE NPI is 1508939554. The provider is registered as an organization entity type.

The provider's business location address is:

1050 N 19TH ST
BLDG. A
PHOENIX, AZ
ZIP 85006-679
Phone: (602) 254-0884

The provider's authorized official is Trish Cocoros .
The authorized official title is Associate Director and has the following contact phone number (602) 254-0884.

The CLIA number assigned to this NPI record is 03D0969083 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/16/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	322D00000X	Residential Treatment Facility, Emotionally Disturbed Children		BH-311	ARIZONA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	455213	OTHER	ARIZONA	AHCCCS PROVIDER #

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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