Basic Information
| Provider Information | |||||||||
| NPI: | 1750466892 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SONORA BEHAVIORAL HEALTH HOSPITAL, LLC | ||||||||
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| OtherOrganizationName: | SONORA BEHAVIORAL HEALTH HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6100 TOWER CIR STE 1000 | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370671509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158611000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6050 N CORONA RD | ||||||||
| Address2: | #3 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857041096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204698700 | ||||||||
| FaxNumber: | 5204698708 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 10/12/2018 | ||||||||
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| AuthorizedOfficialLastName: | HOWARD | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP & TREASURERY | ||||||||
| AuthorizedOfficialTelephone: | 6158617566 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | SH-4089 | AZ | Y | Hospitals | Psychiatric Hospital |
ID Information
| ID | Type | State | Issuer | Description | 172145 | 05 | AZ | MEDICAID | AZ0206281 | 01 | ARIZONA BCBS | OTHER |