Provider Demographics
NPI:1598231268
Name:INTEGRO BEHAVIORAL HOSPITAL
Entity Type:Organization
Organization Name:INTEGRO BEHAVIORAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:VALERIO
Authorized Official - Last Name:CANULLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-571-6521
Mailing Address - Street 1:1501 E ORANGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5130
Mailing Address - Country:US
Mailing Address - Phone:602-535-8200
Mailing Address - Fax:602-457-2517
Practice Address - Street 1:1501 E ORANGEWOOD AVE STE D
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5130
Practice Address - Country:US
Practice Address - Phone:602-535-8200
Practice Address - Fax:605-457-2517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-19
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital