Provider Demographics
NPI:1346675394
Name:CORAZON INC.
Entity Type:Organization
Organization Name:CORAZON INC.
Other - Org Name:CORAZON INTEGRATED HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENACHACA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:520-836-4278
Mailing Address - Street 1:900 E FLORENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-4666
Mailing Address - Country:US
Mailing Address - Phone:520-836-4278
Mailing Address - Fax:
Practice Address - Street 1:936 F AVE STE A&B
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:AZ
Practice Address - Zip Code:85607-2001
Practice Address - Country:US
Practice Address - Phone:520-836-4278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4382251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ584944Medicaid
AZZ149620Medicare PIN