Healthcare Provider Details

I. General information

NPI: 1821643933
Provider Name (Legal Business Name): RED MOUNTAIN TREATMENT CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2745 S ALMA SCHOOL RD STE 3
CHANDLER AZ
85286-4405
US

IV. Provider business mailing address

2745 S ALMA SCHOOL RD STE 3
CHANDLER AZ
85286-4405
US

V. Phone/Fax

Practice location:
  • Phone: 480-626-1746
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JORDAN TENNANT
Title or Position: DC
Credential:
Phone: 999-999-9999