MEDICARE: REDROCK BEHAVIORAL HEALTH LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	103T00000X	Psychologist
3	1041C0700X	Clinical Social Worker
4	251B00000X	Case Management Agency
5	251S00000X	Community/Behavioral Health Agency
6	261Q00000X	Clinic/Center
7	261QC1500X	Community Health Clinic/Center
8	261QH0100X	Health Service Clinic/Center
9	261QM1300X	Multi-Specialty Clinic/Center
10	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)
11	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
12	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1366380339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REDROCK BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	1013 E WASHINGTON ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85034-1007
Country	:	US
Telephone Number	:	229-343-6530
Fax Number	:

Provider Business Practice Location Address
First Line	:	1013 E WASHINGTON ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85034-1007
Country	:	US
Telephone Number	:	229-343-6530
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROSHANAK RIDLEY
Credential	:
Telephone Number	:	229-343-6530

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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