Provider Demographics
NPI:1962010595
Name:TENACITY INTEGRATED BEHAVIORAL HEALTHCARE, PLLC
Entity Type:Organization
Organization Name:TENACITY INTEGRATED BEHAVIORAL HEALTHCARE, PLLC
Other - Org Name:TENACITY INTEGRATED BEHAVIORAL HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:BOSE
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:ANIFOWOSE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:623-565-2668
Mailing Address - Street 1:1075 W AVALON CANYON DR
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-6706
Mailing Address - Country:US
Mailing Address - Phone:623-565-2668
Mailing Address - Fax:520-635-5510
Practice Address - Street 1:1075 W AVALON CANYON DR
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-6706
Practice Address - Country:US
Practice Address - Phone:623-565-2668
Practice Address - Fax:520-635-5510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Single Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility