Healthcare Provider Details

I. General information

NPI: 1285598466
Provider Name (Legal Business Name): INTRACOASTAL BEHAVIORAL HEALTH RECOVERY & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 E BROADWAY BLVD STE 1700
TUCSON AZ
85711-3788
US

IV. Provider business mailing address

5151 E BROADWAY BLVD STE 1700
TUCSON AZ
85711-3788
US

V. Phone/Fax

Practice location:
  • Phone: 520-286-2503
  • Fax:
Mailing address:
  • Phone: 520-286-2503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. SOPHIA FALANA
Title or Position: OWNER
Credential: DNP-PMNP-BC
Phone: 520-286-2503