LAKE MONTEZUMA RTC LLC NPI 1972923472

NPI Information

LAKE MONTEZUMA RTC, LLC is a residential treatment facility emotionally disturbed children in Rimrock, AZ. The provider is a residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently. LAKE MONTEZUMA RTC, LLC NPI is 1972923472. The provider is registered as an organization entity type.
The provider Is Doing Business As Sedona Sky Academy.

The provider's business location address is:

3090 CORONADO TRAIL
RIMROCK, AZ
ZIP 86335-283
Phone: (928) 567-1322
Fax: (928) 567-1323

The provider's authorized official is Tammy Behrmann .
The authorized official title is Executive Director and has the following contact phone number (928) 567-1322.

The CLIA number assigned to this NPI record is 03D2197713 - school/student health service with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/23/2014 and was last updated on 4/23/2014.

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:

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