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General NPI Number Information
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NPI Number | 1215568324
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Entity Type | Organization
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Legal Business Name | RED ROCK FAMILY SERVICES LLC
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Dates
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Enumeration Date | 01/28/2020
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Last Update Date | 01/28/2020
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Provider Practice Location Address
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Address Line | 707 E MINGUS AVE STE 400
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City | COTTONWOOD
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State | AZ
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Zip | 86326-3746
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Country | US
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Telephone | 928-649-0447
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Fax | 928-350-6417
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Provider Business Mailing Address
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Address Line | 707 E MINGUS AVE STE 400
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City | COTTONWOOD
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State | AZ
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Zip | 86326-3746
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Country | US
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Telephone | 928-649-0447
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Fax | 928-350-6417
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Authorized Official
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Title or Position | CEO
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Name | LESLIE WADE KING
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Credential |
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Telephone | 832-451-2628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | 251500000X
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License Number | OTC10066
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License Number State | AZ
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