Provider Demographics
NPI:1154846517
Name:INTEGRO HEALTH SYSTEMS, INC.
Entity Type:Organization
Organization Name:INTEGRO HEALTH SYSTEMS, INC.
Other - Org Name:INTEGRO HEALTH SYSTEMS OUTPATIENT SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:VALERIO
Authorized Official - Last Name:CANULLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-571-6521
Mailing Address - Street 1:1501 E ORANGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5130
Mailing Address - Country:US
Mailing Address - Phone:602-535-8200
Mailing Address - Fax:602-457-2517
Practice Address - Street 1:2728 N 24TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-1050
Practice Address - Country:US
Practice Address - Phone:602-535-8200
Practice Address - Fax:602-457-2517
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRO HEALTH SYSTEMS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-07
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health