Provider Demographics
NPI:1245777481
Name:SONORA BEHAVIORAL HEALTH HOSPITAL, LLC
Entity Type:Organization
Organization Name:SONORA BEHAVIORAL HEALTH HOSPITAL, LLC
Other - Org Name:SONORA BEHAVIORAL HEALTH - OUTPATIENT SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:VP & SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-861-6000
Mailing Address - Street 1:6100 TOWER CIRCLE
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3130 E BROADWAY BLVD STE 196
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-5863
Practice Address - Country:US
Practice Address - Phone:520-399-8688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2023-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ172145Medicaid
AZ034022Medicare Oscar/Certification
AZ172145Medicaid