Provider Demographics
NPI:1063878502
Name:RED ROCK ADDICTION AND TREATMENT COMPANY, LLC
Entity type:Organization
Organization Name:RED ROCK ADDICTION AND TREATMENT COMPANY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF REVENUE CYCLE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-247-1428
Mailing Address - Street 1:PO BOX 29650
Mailing Address - Street 2:DEPT# 880130
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9650
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3512 N HIGLEY RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-9713
Practice Address - Country:US
Practice Address - Phone:602-833-8452
Practice Address - Fax:480-718-8839
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CANYON ROCK MANAGEMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-14
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4857324500000X
AZOTC7625324500000X, 324500000X
AZBH4789324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility