Provider Demographics
NPI:1457897027
Name:SONORAN SKY COMMUNITY SERVICES
Entity Type:Organization
Organization Name:SONORAN SKY COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:SOYARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-216-0518
Mailing Address - Street 1:9601 N BLACK CANYON HWY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-2702
Mailing Address - Country:US
Mailing Address - Phone:602-216-0518
Mailing Address - Fax:602-674-0942
Practice Address - Street 1:7524 W. ALEXANDRIA WAY
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381
Practice Address - Country:US
Practice Address - Phone:623-878-6635
Practice Address - Fax:602-674-0942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4677320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH4677OtherHEALTH PLAN