Provider Demographics
NPI:1679756621
Name:HAVEN SENDERO DE SONORA
Entity Type:Organization
Organization Name:HAVEN SENDERO DE SONORA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-469-8700
Mailing Address - Street 1:6050 N CORONA RD BLDG 3
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1097
Mailing Address - Country:US
Mailing Address - Phone:520-469-8700
Mailing Address - Fax:520-878-2320
Practice Address - Street 1:2502 N DODGE BLVD STE 160
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-2674
Practice Address - Country:US
Practice Address - Phone:520-618-8901
Practice Address - Fax:520-618-8902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH2869102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ156993OtherAHCCCS
AZ1184814550OtherNPI