Basic Information
| Provider Information | |||||||||
| NPI: | 1790293355 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CORAZON A CORAZON BEHAVIOR HEALTH LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3100 MILL ST STE 215 | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895022217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7755077078 | ||||||||
| FaxNumber: | 7755077079 | ||||||||
| Practice Location | |||||||||
| Address1: | 3100 MILL ST STE 215 | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7755077078 | ||||||||
| FaxNumber: | 7755077079 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2018 | ||||||||
| LastUpdateDate: | 05/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | GARCIA DIAZ | ||||||||
| AuthorizedOfficialFirstName: | ARACELI | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7755077078 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320600000X | Y | Residential Treatment Facilities | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
No ID Information.