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Organization

ROSEWOOD RANCH

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TYEAST REYNOLDS (DIRECTOR OF RCM)
(678) 813-0428
Entity
Organization

Contact information

Practice address
521 W WICKENBURG WAY, WICKENBURG, AZ 85390-5200
(928) 684-8981
(928) 684-9562
Mailing address
2300 WINDY RIDGE PKWY SE STE 210, ATLANTA, GA 30339-5665
(470) 440-1647
(470) 440-1647

Taxonomy

Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
BH-2495
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
AZ0205580
BCBS OF AZ
AZ
Enumeration date
05/02/2007
Last updated
04/11/2019
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