SEQUELCARE OF ARIZONA LLC NPI 1003060534

NPI Information

NPI: 1003060534
Provider Name: SEQUELCARE OF ARIZONA, LLC

Other Name: BLUE RIDGE

Classification: Community Based Residential Treatment Facility, Mental Illness - 320800000X
Entity Type: Organization
Address:
14410 E. BLUE RIDGE ROAD
DEWEY, AZ
ZIP 86327
Phone: (928) 632-8078
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SEQUELCARE OF ARIZONA, LLC is a community based residential treatment facility mental illness in Dewey, AZ. The provider is a home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. SEQUELCARE OF ARIZONA, LLC NPI is 1003060534. The provider is registered as an organization entity type.
The provider Other Name Is Blue Ridge.

The provider's business location address is:

14410 E. BLUE RIDGE ROAD
DEWEY, AZ
ZIP 86327
Phone: (928) 632-8078

The provider's authorized official is Nadine Ramirez .
The authorized official title is Deputy Director and has the following contact phone number (926) 777-3280.

The enumeration date for this NPI number is 11/11/2008 and was last updated on 2/1/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	320800000X	Community Based Residential Treatment Facility, Mental Illness		BH-3197	ARIZONA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	BH3	OTHER		LICENSE NUMBER BH3197
2	824509	MEDICAID	ARIZONA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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