Healthcare Provider Details

I. General information

NPI: 1184814550
Provider Name (Legal Business Name): HAVEN SENDERO DE SONORA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 07/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 N DODGE BLVD SUITE 160
TUCSON AZ
85716-2671
US

IV. Provider business mailing address

2502 N DODGE BLVD SUITE 160
TUCSON AZ
85716-2671
US

V. Phone/Fax

Practice location:
  • Phone: 520-618-8901
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberBH2869
License Number StateAZ

VIII. Authorized Official

Name: MR. WILLIAM PAGE BARNES
Title or Position: CFO
Credential:
Phone: 615-250-9091