Basic Information
| Provider Information | |||||||||
| NPI: | 1518925163 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SONORA BEHAVIORAL HEALTH HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6050 N CORONA RD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857041096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204698700 | ||||||||
| FaxNumber: | 5204698708 | ||||||||
| Practice Location | |||||||||
| Address1: | 6050 N CORONA RD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857041096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204698700 | ||||||||
| FaxNumber: | 5204698708 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PETRONI | ||||||||
| AuthorizedOfficialFirstName: | FRANK | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF OF BUSINESS DEVELOPMENT | ||||||||
| AuthorizedOfficialTelephone: | 5205446696 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | SH 2360 | AZ | Y | Hospitals | Psychiatric Hospital |
ID Information
| ID | Type | State | Issuer | Description | 486325 | 05 | AZ | MEDICAID |