Provider Demographics
NPI:1174774608
Name:YAJCINLLC
Entity type:Organization
Organization Name:YAJCINLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KWADWO
Authorized Official - Middle Name:
Authorized Official - Last Name:KANTANKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-393-0662
Mailing Address - Street 1:1609 E HEATHER DR
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85240-5682
Mailing Address - Country:US
Mailing Address - Phone:480-393-0662
Mailing Address - Fax:602-283-3476
Practice Address - Street 1:1609 E HEATHER DR
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85240-5682
Practice Address - Country:US
Practice Address - Phone:480-393-0662
Practice Address - Fax:602-283-3476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-3086322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children