Provider Demographics
NPI:1639681646
Name:RED HAWK BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:RED HAWK BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SIUTA
Authorized Official - Middle Name:S
Authorized Official - Last Name:FAAOOTOA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-236-5424
Mailing Address - Street 1:748 E 900 S
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-5543
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3767 SOUTH SCENIC BLVD
Practice Address - Street 2:
Practice Address - City:LITTLEFIELD
Practice Address - State:AZ
Practice Address - Zip Code:86432
Practice Address - Country:US
Practice Address - Phone:435-236-5423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-31
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH5273320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness