LAKE MONTEZUMA RTC, LLC (NPI# 1972923472) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972923472 |
| Entity Type | Organization |
| Organization Name | LAKE MONTEZUMA RTC, LLC |
| Other Organization Name | SEDONA SKY ACADEMY |
| Practice Address |
3090 Coronado Trail Rimrock AZ 86335-5283 |
| Practice Telephone | 9285671322 |
| Practice Fax Number | 9285671323 |
| Mailing Telephone | 9285671322 |
| Mailing Fax Number | 9285671323 |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2014-04-23 |
| Authorized Official Name | TAMMY BEHRMANN (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 9285671322 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | BH4470 | AZ | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Sedona Sky Academy | Doing Business As Name - Organization |
| Street Address |
3090 CORONADO TRAIL |
| City | RIMROCK |
| State | AZ |
| Zip Code | 86335-5283 |
| 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 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205442035 | Rodney Kent Courtney | Emergency Medical Technician, Paramedic | 4930 N. Tenderfoot Trail, Rimrock, AZ 86335 | 2020-09-17 |
| 1750726667 | Stevie Stanford | Psychologist | 3095 Coronado Trail, Rimrock, AZ 86335 | 2013-05-06 |
| 1992855779 | Stacy Ellen Mclaughlin | Massage Therapist | 4030 E Lake Shore Dr, Rimrock, AZ 86335 | 2007-01-12 |
| 1891119822 | Ariella Allaman | Counselor | 3095 Coronado Trail, Rimrock, AZ 86335 | 2014-02-11 |
| 1487091963 | Isabelle Shook | Counselor | 3095 Coronado Trail, Rim Rock, AZ 86335 | 2013-05-24 |
| 1275978900 | Copper Canyon Academy | Residential Treatment Facility, Emotionally Disturbed Children | 3095 Coronado Trail, Lake Montezuma, AZ 86335 | 2013-05-08 |
| 1528403243 | Kathleen Jo Buri-baca | Counselor | 3095 Coronado Trail, Rimrock, AZ 86335-0230 | 2013-05-08 |
| 1851736565 | D. Taylor Watts | Counselor | 3095 Coronado Trail, Rimrock, AZ 86335-0230 | 2013-05-08 |
| 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 |
| 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 |
|---|---|---|---|---|
| 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 |
| 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 | ||||
Please comment or provide details below to improve the information on LAKE MONTEZUMA RTC, LLC.
| 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.