NPI 1972923472

Lake Montezuma Rtc, LLC

Organisation Emotionally Disturbed Childrens' Residential Treatment Facility Rimrock, AZ

Practice location

Address: 3090 Coronado Trail, Rimrock, AZ 86335-5283
Phone: (928) 567-1322
Fax: (928) 567-1323

Authorised official

Name: Tammy Behrmann
Title: Executive Director
Phone: (928) 567-1322

Registered specialties

Emotionally Disturbed Childrens' Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 322D00000X Licence BH4470 (AZ)

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Registry record

NPI: 1972923472
Entity type: Organization
NPI issued: 23 Apr 2014
Record last updated: 23 Apr 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.