Healthcare Provider Details

I. General information

NPI: 1457466815
Provider Name (Legal Business Name): RED MOUNTAIN BEHAVIORAL HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 W ELLIOT RD STE 103
GILBERT AZ
85233-5127
US

IV. Provider business mailing address

890 W ELLIOT RD STE 103
GILBERT AZ
85233-5127
US

V. Phone/Fax

Practice location:
  • Phone: 480-641-9552
  • Fax: 480-222-0215
Mailing address:
  • Phone: 480-641-9552
  • Fax: 480-222-0215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberBH4092
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberBH2664
License Number StateAZ

VIII. Authorized Official

Name: SARAH RUANE
Title or Position: OWNER
Credential:
Phone: 480-641-9552