1831371723 NPI number — RED MOUNTAIN BEHAVIORAL HEALTH SERVICES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831371723 NPI number — RED MOUNTAIN BEHAVIORAL HEALTH SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RED MOUNTAIN BEHAVIORAL HEALTH SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831371723
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
890 W ELLIOT RD STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GILBERT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85233-5127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-641-9552
Provider Business Mailing Address Fax Number:
480-981-0893

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1533 S SOMERSET CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85206-6766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-641-9552
Provider Business Practice Location Address Fax Number:
480-981-0893
Provider Enumeration Date:
12/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RUANE
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
480-641-9552

Provider Taxonomy Codes

  • Taxonomy code: 385HR2055X , with the licence number:  BH-3632 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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