Provider Demographics
NPI:1649657412
Name:CORAZON INTEGRATED HEALTHCARE SERVICES
Entity type:Organization
Organization Name:CORAZON INTEGRATED HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LISAC
Authorized Official - Phone:520-836-4278
Mailing Address - Street 1:900 E FLORENCE BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-4666
Mailing Address - Country:US
Mailing Address - Phone:520-836-4278
Mailing Address - Fax:
Practice Address - Street 1:900 E FLORENCE BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4666
Practice Address - Country:US
Practice Address - Phone:520-836-4278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC6641251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health