Provider Demographics
NPI:1811289010
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: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:480-641-9552
Mailing Address - Fax:480-981-0893
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:480-981-0893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-05
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH3636251S00000X
AZBH3637251S00000X
AZBH3633251S00000X
AZBH3635251S00000X
AZBH3634251S00000X
AZBH4012251S00000X
AZBH3632251S00000X
AZBH3631251S00000X
AZBH3639251S00000X
AZBH3640251S00000X
AZBH3638251S00000X
AZBH3728251S00000X
AZBH2664251S00000X
AZBH3792251S00000X
AZBH4092251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ610782Medicaid