Organization
SEQUELCARE OF ARIZONA, LLC
Active
Other names
Katilin Ranch
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NADINE RAMIREZ (DEPUTY DIRECTOR)
(928) 777-3280
Entity
Organization
Contact information
Practice address
6070 N. TREADWAY TRAIL, FLAGSTAFF, AZ 86004
(928) 526-1499
(928) 526-1151
Mailing address
8603 E. EASTRIDGE DRIVE, STE. A, PRESCOTT VALLEY, AZ 86314
(928) 777-3280
(928) 778-1252
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH-3337
AZ
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
BH-3337
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
717407
AHCCCS ID
AZ
05
—
871211
—
AZ
Enumeration date
10/11/2006
Last updated
04/12/2012
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