Provider Demographics
NPI:1295129823
Name:TERROS, INC.
Entity type:Organization
Organization Name:TERROS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN HOFFMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:602-685-6000
Mailing Address - Street 1:3003 N CENTRAL AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2929
Mailing Address - Country:US
Mailing Address - Phone:602-685-6000
Mailing Address - Fax:602-302-7925
Practice Address - Street 1:3385 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2306
Practice Address - Country:US
Practice Address - Phone:602-685-6000
Practice Address - Fax:602-302-7925
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TERROS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-20
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCSLG8649261QM0801X
AZOTC-5878261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ017032Medicaid
AZ017032Medicaid