Provider Demographics
NPI:1447554878
Name:CORAZON INC.
Entity type:Organization
Organization Name:CORAZON INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENCHACA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:520-836-4278
Mailing Address - Street 1:900 E FLORENCE BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-4673
Mailing Address - Country:US
Mailing Address - Phone:520-836-4278
Mailing Address - Fax:520-836-3721
Practice Address - Street 1:1815 E 9TH ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:AZ
Practice Address - Zip Code:85607-3429
Practice Address - Country:US
Practice Address - Phone:520-364-3630
Practice Address - Fax:520-364-2565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH3747302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization