# SACRED MOUNTAIN HOME CARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700029022
- **Authorized official:** MR. TONY DERALD LILLY (CEO)
- **Authorized official phone:** (505) 612-9119

## Contact information

- **Practice address:** 2 MILES WEST OF DAYS INN ON HWY 264, ST. MICHAELS, AZ 86511-0315
- **Practice address phone:** (505) 612-9119
- **Mailing address:** PO BOX 315, ST MICHAELS, AZ 86511-0315
- **Mailing address phone:** (505) 612-9119

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 04/16/2009
- **Last updated:** 04/16/2009