Provider Demographics
NPI:1932274180
Name:COLORADO RIVER BEHAVIORAL HEALTH SYSTEM
Entity type:Organization
Organization Name:COLORADO RIVER BEHAVIORAL HEALTH SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-720-9249
Mailing Address - Street 1:1340 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-4626
Mailing Address - Country:US
Mailing Address - Phone:928-261-8668
Mailing Address - Fax:928-782-5701
Practice Address - Street 1:1340 S 4TH AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-4626
Practice Address - Country:US
Practice Address - Phone:641-494-8110
Practice Address - Fax:928-782-5701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCSA08ADHS0202251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ090458Medicaid
AZ384591Medicaid