SEQUELCARE OF ARIZONA, LLC (NPI# 1770676439) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770676439 |
| Entity Type | Organization |
| Organization Name | SEQUELCARE OF ARIZONA, LLC |
| Other Organization Name | HUALAPAI MOUNTAIN |
| Practice Address |
3240 Hualapai Mountain Road Kingman AZ 86401 |
| Mailing Address |
8603 E. Eastridge Drive Ste. A Prescott Valley AZ 86314 |
| Practice Telephone | 9287532665 |
| Practice Fax Number | 9287531556 |
| Mailing Telephone | 9287773280 |
| Mailing Fax Number | 9287171660 |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2011-07-07 |
| Authorized Official Name | MRS. NADINE RAMIREZ (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 9287773280 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | BH-3903 | AZ | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | AHCCCS ID | 954603 | 01 |
| AZ | 954603 | 05 |
| Other Name | Type Code |
|---|---|
| Hualapai Mountain | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275860702 | Sequelcare of Arizona, LLC | Community/Behavioral Health | 450 West 5th Place, Mesa, AZ 85201 | 2009-11-04 |
| 1003060534 | Sequelcare of Arizona, LLC | Community Based Residential Treatment Facility, Mental Illness | 14410 E. Blue Ridge Road, Dewey, AZ 86327 | 2008-11-11 |
| 1063663391 | Sequelcare of Arizona, LLC | Community Based Residential Treatment Facility, Mental Illness | 3160 N. Pine View Drive, Prescott Valley, AZ 86314-2534 | 2008-10-06 |
| 1154443331 | Sequelcare of Arizona, LLC | Public Health or Welfare | 8603 E. Eastridge Drive, Ste. A, Prescott Valley, AZ 86314 | 2007-04-06 |
| 1376601914 | Sequelcare of Arizona, LLC | Counselor | 3170 Stillwater Dr., Prescott, AZ 86305 | 2006-12-05 |
| 1588740930 | Sequelcare of Arizona, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 9435 E Smoki Trail, Dewey, AZ 86327-6990 | 2006-10-28 |
| 1184712143 | Sequelcare of Arizona, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 6070 N. Treadway Trail, Flagstaff, AZ 86004 | 2006-10-11 |
| 1780777540 | Sequelcare of Arizona, LLC | Community Based Residential Treatment Facility, Mental Illness | 4001 North Catherine Drive, Prescott Valley, AZ 86314 | 2006-10-02 |
| 1124407390 | Sequelcare of Arizona, LLC | Behavioral Analyst | 8603 E Eastridge Rd, Prescott Valley, AZ 86314-8562 | 2015-05-21 |
| Street Address |
3240 HUALAPAI MOUNTAIN ROAD |
| City | KINGMAN |
| State | AZ |
| Zip Code | 86401 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053858704 | Robert Cole | Nurse Practitioner | 3545 Cheyenne Ave, King,an, AZ 86401 | 2017-01-19 |
| 1710420286 | Acadia Healthcare Inc | Nurse Practitioner | 2699 E Andy Devine, Suite B, Kingman, AZ 86401 | 2016-11-30 |
| 1174079800 | Kenneth Mcadow | Physical Therapist | 2404 Stockton Hill Road, Suite K, Kingman, AZ 86401 | 2016-09-01 |
| 1649659483 | Tracie Hirz | Case Manager/Care Coordinator | 3656 Packsaddle Road, Kingman, AZ 86401 | 2015-05-27 |
| 1548657695 | Chelsea Presbrey | Family Medicine | 2202 N Stockton Hill Rd Ste 100, Kingman, AZ 86401 | 2015-04-15 |
| 1649617226 | Abubakr Abdelmunim Tagelsir Abdelaziz | Internal Medicine | 2501 N Stockton Hill Rd Ste 102, Kingman, AZ 86401 | 2013-05-23 |
| 1205173325 | Patricia Jean Marko | Social Worker | 2002 Stockton Hill Road, Mohave Mental Health Clinic, Inc., Kingman, AZ 86401 | 2013-01-09 |
| 1770835316 | Hae Young Lee | Dentist | 2058 Maya Dr., Kingman, AZ 86401 | 2012-10-05 |
| 1255681623 | Hilary Radler | Specialist/Technologist | 3033 Macdonald, Kingman, AZ 86401 | 2012-09-13 |
| 1477836880 | Goodwill of Northern Arizona | Exclusive Provider Organization | 2369 Airway Avenue, Kingman, AZ 86401 | 2011-09-21 |
| Find all providers in zip 86401 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689195901 | Mohave Mental Health Clinic, Inc. | Community Based Residential Treatment Facility, Mental Illness | 3745 N Diamond Dr, Kingman, AZ 86409-3328 | 2017-06-28 |
| 1861562423 | Mohave Mental Health Clinic Inc | Community Based Residential Treatment Facility, Mental Illness | 1080 Sheldon Ave, Kingman, AZ 86409 | 2006-11-09 |
| 1124198791 | Mohave Mental Health Clinic Inc | Community Based Residential Treatment Facility, Mental Illness | 1091 Calumet Ave, Kingman, AZ 86409-0503 | 2006-11-09 |
| 1831756659 | Mohave Mental Health Clinic Inc | Community Based Residential Treatment Facility, Mental Illness | 1743 Sycamore Ave, Kingman, AZ 86409-0927 | 2019-05-28 |
| 1629528716 | Exclusive Certified Residential Care, LLC | Community Based Residential Treatment Facility, Mental Illness | 3744 Martingale Dr, Kingman, AZ 86409-2994 | 2016-10-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811598253 | Pinnacle Behavioral Health LLC | Community Based Residential Treatment Facility, Mental Illness | 45369 W Horse Mesa Rd, Maricopa, AZ 85139-9128 | 2020-11-03 |
| 1649878687 | Ayobami Noheem Agoro | Community Based Residential Treatment Facility, Mental Illness | 12362 W Joblanca Rd, Avondale, AZ 85323-3130 | 2020-10-13 |
| 1235736018 | Happy Valley Community Services LLC | Community Based Residential Treatment Facility, Mental Illness | 1106 E Cochise Dr, Phoenix, AZ 85020-1550 | 2020-10-05 |
| 1144835968 | Jfox II LLC | Community Based Residential Treatment Facility, Mental Illness | 5327 E Enrose Cir, Mesa, AZ 85205-5489 | 2020-09-09 |
| 1639782956 | Ascend Behavioral Health and Wellness,llc | Community Based Residential Treatment Facility, Mental Illness | 3308 W Desert Vista Trl, Phoenix, AZ 85083-5874 | 2020-08-26 |
| 1952913998 | Vema Corporation | Community Based Residential Treatment Facility, Mental Illness | 12701 N 79th Dr, Peoria, AZ 85381-9049 | 2020-08-20 |
| 1720698509 | Lyddia Getaweru | Community Based Residential Treatment Facility, Mental Illness | 2767 W Peggy Dr, Queen Creek, AZ 85142-6686 | 2020-08-05 |
| 1689284531 | Brain Solutions Pllc | Community Based Residential Treatment Facility, Mental Illness | 4555 S Maverick Ct, Gilbert, AZ 85297-9532 | 2020-08-05 |
| 1548879950 | C&j Care Home LLC | Community Based Residential Treatment Facility, Mental Illness | 4418 W Darrel Rd, Laveen, AZ 85339-6222 | 2020-07-31 |
| 1295353019 | Alliance Behavioral Care LLC | Community Based Residential Treatment Facility, Mental Illness | 2840 S Chaparral Blvd, Gilbert, AZ 85295-7675 | 2020-07-08 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.