1538669684 NPI number — SONORAN SKY COMMUNITY SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538669684 NPI number — SONORAN SKY COMMUNITY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SONORAN SKY COMMUNITY SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538669684
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9601 N BLACK CANYON HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85021-2702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-216-0518
Provider Business Mailing Address Fax Number:
602-674-0942

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
417 E TIERRA BUENA LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85022-3034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-603-1735
Provider Business Practice Location Address Fax Number:
602-674-0942
Provider Enumeration Date:
02/15/2018

Additional Information

Authorized Official

Authorized Official Last Name:
SOYARS
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
CAROL
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
602-216-0518

Provider Taxonomy Codes

  • Taxonomy code: 320800000X , with the licence number:  BH5367 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 320800000X . This is a "320800000X" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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