COPPER CANYON ACADEMY (NPI# 1275978900) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275978900 |
| Entity Type | Organization |
| Organization Name | COPPER CANYON ACADEMY |
| Practice Address |
3095 Coronado Trail Lake Montezuma AZ 86335 |
| Mailing Address |
Po Box 230 Rimrock AZ 86335-0230 |
| Practice Telephone | 9285671322 |
| Mailing Telephone | 9285671322 |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2013-05-16 |
| Authorized Official Name | ARIELLA ALLAMAN (THERAPIST) |
| Authorized Official Telephone | 9285671322 |
| Authorized Official Credential | MA, LAC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | AZ BOARD OF BEHAVIORAL HEALTH EXAMINERS | LAC-13769 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205070786 | Copper Canyon Academy | Residential Treatment Facility, Emotionally Disturbed Children | 3090 Coronado Trail, Rimrock, AZ 86335 | 2009-04-28 |
| 1972849149 | Copper Canyon Academy | Residential Treatment Facility, Emotionally Disturbed Children | 3090 Coronado Trail, Rimrock, AZ 86335 | 2012-12-17 |
| Street Address |
3095 CORONADO TRAIL |
| City | LAKE MONTEZUMA |
| State | AZ |
| Zip Code | 86335 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205442035 | Rodney Kent Courtney | Emergency Medical Technician, Paramedic | 4930 N. Tenderfoot Trail, Rimrock, AZ 86335 | 2020-09-17 |
| 1205070786 | Copper Canyon Academy | Residential Treatment Facility, Emotionally Disturbed Children | 3090 Coronado Trail, Rimrock, AZ 86335 | 2009-04-28 |
| 1992855779 | Stacy Ellen Mclaughlin | Massage Therapist | 4030 E Lake Shore Dr, Rimrock, AZ 86335 | 2007-01-12 |
| 1972849149 | Copper Canyon Academy | Residential Treatment Facility, Emotionally Disturbed Children | 3090 Coronado Trail, Rimrock, AZ 86335 | 2012-12-17 |
| 1073506416 | Montezuma Rimrock Fire District | Ambulance | 3240 E Beaver Creek Rd, Rimrock, AZ 86335-5127 | 2005-08-30 |
| 1851534432 | Arizona Security & Home Automation, Inc | Emergency Response System Companies | 3465 E Airport Dr, Rimrock, AZ 86335-5150 | 2009-04-13 |
| 1972923472 | Lake Montezuma Rtc, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 3090 Coronado Trail, Rimrock, AZ 86335-5283 | 2014-04-23 |
| 1003399403 | Mark Gonchar | Counselor | 3095 E Coronado Trl, Rimrock, AZ 86335-5284 | 2018-09-11 |
| 1558845818 | Kathleen Hourihan | Social Worker | 3095 E Coronado Trl, Rimrock, AZ 86335-5284 | 2018-09-21 |
| 1114401916 | Tamara Cy Garden | Counselor | 3095 E Coronado Trl, Rimrock, AZ 86335-5284 | 2018-09-18 |
| Find all providers in zip 86335 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528666039 | Rehoboth LLC | Residential Treatment Facility, Emotionally Disturbed Children | 46136 W Mountain View Rd # A, Maricopa, AZ 85139-6796 | 2020-10-16 |
| 1962022665 | New Hope of Arizona, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 8710 W Watkins St, Tolleson, AZ 85353-9028 | 2020-04-22 |
| 1639798143 | Anthony Udoinwang | Residential Treatment Facility, Emotionally Disturbed Children | 10435 W Reade Ave, Glendale, AZ 85307-4237 | 2020-04-14 |
| 1033756358 | Native Music Coalition | Residential Treatment Facility, Emotionally Disturbed Children | 5150 S Crazy Cat Ln, Tucson, AZ 85735 | 2019-12-05 |
| 1013558311 | Back To Life Incorporated | Residential Treatment Facility, Emotionally Disturbed Children | 6420 W Cocopah St, Phoenix, AZ 85043 | 2019-10-08 |
| 1487118865 | Serenity Preferred LLC | Residential Treatment Facility, Emotionally Disturbed Children | 17829 W Columbine Dr, Surprise, AZ 85388-5628 | 2019-01-30 |
| 1407333958 | Copa's Caring Hands LLC. | Residential Treatment Facility, Emotionally Disturbed Children | 42251 W Bravo Dr, Maricopa, AZ 85138-2295 | 2018-07-26 |
| 1538668983 | Starks Homes LLC | Residential Treatment Facility, Emotionally Disturbed Children | 7325 E Fayette St, Tucson, AZ 85730-2324 | 2018-02-12 |
| 1881100147 | Anna Marie Barrios | Residential Treatment Facility, Emotionally Disturbed Children | 18811 N 7th Dr, Phoenix, AZ 85027-5508 | 2017-12-22 |
| 1033625926 | Youth Transition Services, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 1190 S Boulder St Unit D, Gilbert, AZ 85296-3792 | 2017-12-14 |
| Find all providers with the same taxonomy | ||||
| City | LAKE MONTEZUMA |
| Zip Code | 86335 |
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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.