Healthcare Provider Details

I. General information

NPI: 1700505872
Provider Name (Legal Business Name): SEDONA SKY OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 11/29/2024
Certification Date: 11/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3090 E CORONADO TRL
RIMROCK AZ
86335-5283
US

IV. Provider business mailing address

3090 E CORONADO TRL
RIMROCK AZ
86335-5283
US

V. Phone/Fax

Practice location:
  • Phone: 928-567-1322
  • Fax:
Mailing address:
  • Phone: 312-485-5680
  • Fax: 928-371-2345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ERIN SMITH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 855-988-9111