RE-CREATION RETREAT LLC NPI 1629339437

NPI Information

  • NPI: 1629339437
  • Provider Name: RE-CREATION RETREAT LLC
  • Classification: Community Based Residential Treatment Facility, Mental Illness - 320800000X
  • Entity Type: Organization
  • Address: 455 SOUTH MAIN
    FREDONIA, AZ
    ZIP 86022
  • Phone: (435) 691-0856

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NPI Details

RE-CREATION RETREAT LLC is a community based residential treatment facility mental illness in Fredonia, AZ. The provider is a home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. RE-CREATION RETREAT LLC NPI is 1629339437. The provider is registered as an organization entity type.

The provider's business location address is:

455 SOUTH MAIN
FREDONIA, AZ
ZIP 86022
Phone: (435) 691-0856

The provider's authorized official is Randy K Soderquist .
The authorized official title is Owner And Clinical Director and has the following contact phone number (435) 691-0856.

The enumeration date for this NPI number is 6/7/2012 and was last updated on 11/21/2012.

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
1324500000XSubstance Abuse Rehabilitation FacilityBH-3895ARIZONANo
2320800000XCommunity Based Residential Treatment Facility, Mental IllnessBH-3895ARIZONAYes

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: 11/21/2025

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