Healthcare Provider Details

I. General information

NPI: 1083994461
Provider Name (Legal Business Name): THE CEDAR SANCTUARY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 08/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4929 EAST LAUREL LANE
SCOTTSDALE AZ
85254
US

IV. Provider business mailing address

610 N ALMA SCHOOL RD STE 24
CHANDLER AZ
85224-3688
US

V. Phone/Fax

Practice location:
  • Phone: 602-374-5483
  • Fax: 480-899-6122
Mailing address:
  • Phone: 480-899-9878
  • Fax: 480-899-6122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHELLA MICHEL
Title or Position: OWNER
Credential:
Phone: 602-723-7714