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NPI Code Detail

MEDICARE: RED ROCK ADDICTION AND TREATMENT COMPANY, LLC

MEDICARE: RED ROCK ADDICTION AND TREATMENT COMPANY, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1324500000XSubstance Abuse Rehabilitation FacilityBH4857AZ
2324500000XSubstance Abuse Rehabilitation FacilityOTC7625AZ

General Provider Information

NPI Number : 1063878502
Entity Type Code : Organization
Provider Name (Legal Business Name) : RED ROCK ADDICTION AND TREATMENT COMPANY, LLC
Provider Business Mailing Address
First Line : PO BOX 29650
Second Line : DEPT# 880130
City : PHOENIX
State : AZ
Zip : 85038-9650
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3512 N HIGLEY RD
Second Line :
City : MESA
State : AZ
Zip : 85215-9713
Country : US
Telephone Number : 602-833-8452
Fax Number : 480-718-8839
Authorized Official
Title or Position : CHIEF REVENUE CYCLE OFFICER
Name : PAULA BEAN
Credential :
Telephone Number : 772-247-1428
Provider Enumeration Date : 01/14/2016
Last Update Date : 12/22/2016

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