Provider Demographics
NPI:1023404548
Name:RED MOUNTAIN BEHAVIORAL HEALTH SERVICES
Entity type:Organization
Organization Name:RED MOUNTAIN BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOBL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-800-6553
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:704-942-1646
Mailing Address - Fax:
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:704-942-1646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-4582385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH-4582OtherAZ DEPT OF HEALTH SERVICES