Provider Demographics
NPI:1518925163
Name:SONORA BEHAVIORAL HEALTH HOSPITAL
Entity Type:Organization
Organization Name:SONORA BEHAVIORAL HEALTH HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF BUSINESS DEVELOPMENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:A
Authorized Official - Last Name:PETRONI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:520-544-6696
Mailing Address - Street 1:6050 N CORONA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1096
Mailing Address - Country:US
Mailing Address - Phone:520-469-8700
Mailing Address - Fax:520-469-8708
Practice Address - Street 1:6050 N CORONA RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1096
Practice Address - Country:US
Practice Address - Phone:520-469-8700
Practice Address - Fax:520-469-8708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSH 2360283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ486325Medicaid
AZ486325Medicaid