MEDICARE: SONORAN PREVENTION WORKS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1609367184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONORAN PREVENTION WORKS

Provider Business Mailing Address
First Line	:	3201 N 16TH ST STE 9
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-7160
Country	:	US
Telephone Number	:	480-442-7086
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201 N 16TH ST STE 9
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-7160
Country	:	US
Telephone Number	:	480-442-7086
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	HALEY COLES
Credential	:
Telephone Number	:	602-388-9870

Provider Enumeration Date	:	05/21/2018
Last Update Date	:	05/21/2018

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Directions to “SONORAN PREVENTION WORKS ” Practice Location

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