Healthcare Provider Details

I. General information

NPI: 1740397058
Provider Name (Legal Business Name): RED MOUNTAIN BEHAVIORAL HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6661 E HERMOSA VISTA DR
MESA AZ
85215-2207
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: 480-981-0893
Mailing address:
  • Phone: 480-641-9552
  • Fax: 480-981-0893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License NumberBH-3633
License Number StateAZ

VIII. Authorized Official

Name: MOSHE LOBL
Title or Position: OWNER
Credential:
Phone: 602-800-6553