Provider Demographics
NPI:1265836837
Name:RED MOUNTAIN RECOVERY, LLC
Entity Type:Organization
Organization Name:RED MOUNTAIN RECOVERY, LLC
Other - Org Name:RED MOUNTAIN SEDONA
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-300-3049
Mailing Address - Street 1:PO BOX 21569
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86341-1569
Mailing Address - Country:US
Mailing Address - Phone:928-300-3049
Mailing Address - Fax:
Practice Address - Street 1:90 BELL ROCK PLZ
Practice Address - Street 2:STE. 100A
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86351-9040
Practice Address - Country:US
Practice Address - Phone:928-300-3049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-10
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health