Provider Demographics
NPI:1568103182
Name:BORABORA INTEGRATED HEALTH SYSTEM
Entity Type:Organization
Organization Name:BORABORA INTEGRATED HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KERUBO
Authorized Official - Middle Name:HAPPINESS
Authorized Official - Last Name:KINARO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BA, BSN, RN
Authorized Official - Phone:410-660-5117
Mailing Address - Street 1:4015 W SALTER DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-2078
Mailing Address - Country:US
Mailing Address - Phone:410-660-5117
Mailing Address - Fax:
Practice Address - Street 1:9299 W OLIVE AVE STE 404
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-8383
Practice Address - Country:US
Practice Address - Phone:410-660-5117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities