Healthcare Provider Details

I. General information

NPI: 1427278837
Provider Name (Legal Business Name): ROSEWOOD RANCH, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36075 S RINCON RD
WICKENBURG AZ
85390-2491
US

IV. Provider business mailing address

2300 WINDY RIDGE PKWY SE STE 210
ATLANTA GA
30339-5665
US

V. Phone/Fax

Practice location:
  • Phone: 928-684-9594
  • Fax: 928-684-9562
Mailing address:
  • Phone: 470-440-1647
  • Fax: 470-440-1647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberBH-1594
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberBH-1594
License Number StateAZ

VIII. Authorized Official

Name: TYEAST REYNOLDS
Title or Position: DIRECTOR OF RCM
Credential:
Phone: 678-813-0428