Provider Demographics
NPI:1457466815
Name:RED MOUNTAIN BEHAVIORAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:RED MOUNTAIN BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:RUANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-641-9552
Mailing Address - Street 1:890 W ELLIOT RD STE 103
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-5127
Mailing Address - Country:US
Mailing Address - Phone:480-641-9552
Mailing Address - Fax:480-222-0215
Practice Address - Street 1:890 W ELLIOT RD STE 103
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-5127
Practice Address - Country:US
Practice Address - Phone:480-641-9552
Practice Address - Fax:480-222-0215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4092251S00000X
261QC1500X
AZBH2664261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ060467Medicaid