Healthcare Provider Details

I. General information

NPI: 1841486651
Provider Name (Legal Business Name): SONORAN THERAPY GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2007
Last Update Date: 09/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3655 W ANTHEM WAY SUITE A-109, PMB 213
ANTHEM AZ
85086-0430
US

IV. Provider business mailing address

3655 W ANTHEM WAY SUITE A-109, PMB 213
ANTHEM AZ
85086-0430
US

V. Phone/Fax

Practice location:
  • Phone: 602-999-0161
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CHAD SLAYBAUGH
Title or Position: SECRETARY / OWNER
Credential:
Phone: 602-999-0161