Provider Demographics
NPI:1528954104
Name:CILICIA'S INTERNATIONAL HOLDING GROUP
Entity type:Organization
Organization Name:CILICIA'S INTERNATIONAL HOLDING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:CILICIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:GOODEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:480-328-4410
Mailing Address - Street 1:PO BOX 5973
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-0617
Mailing Address - Country:US
Mailing Address - Phone:480-328-4410
Mailing Address - Fax:
Practice Address - Street 1:1499 N 159TH AVE APT 2202
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-7204
Practice Address - Country:US
Practice Address - Phone:480-328-4410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1720727688Medicaid