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General NPI Number Information
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NPI Number | 1346675394
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Entity Type | Organization
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Legal Business Name | CORAZON INC.
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Dates
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Enumeration Date | 09/10/2013
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Last Update Date | 09/30/2013
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Provider Practice Location Address
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Address Line | 936 F AVE STE A&B
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City | DOUGLAS
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State | AZ
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Zip | 85607-2001
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Country | US
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Telephone | 520-836-4278
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Fax |
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Provider Business Mailing Address
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Address Line | 900 E FLORENCE BLVD
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City | CASA GRANDE
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State | AZ
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Zip | 85122-4666
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Country | US
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Telephone | 520-836-4278
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TERESA MENACHACA
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Credential | LCSW
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Telephone | 520-836-4278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 4382
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License Number State | AZ
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