Provider Demographics
NPI:1447615042
Name:COBROS III, LLC
Entity Type:Organization
Organization Name:COBROS III, LLC
Other - Org Name:DESERT HORIZONS COMMUNITIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:COLONNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-615-2255
Mailing Address - Street 1:PO BOX 43908
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85733-3908
Mailing Address - Country:US
Mailing Address - Phone:520-615-2255
Mailing Address - Fax:
Practice Address - Street 1:7336 E 28TH PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-5559
Practice Address - Country:US
Practice Address - Phone:520-615-2255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ405971251S00000X, 310500000X, 315P00000X
320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities