Organization
SEQUELCARE OF ARIZONA, LLC
Active
Other names
Tap Program Mesa
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NADINE RAMIREZ (DEPUTY DIRECTOR)
(928) 777-3280
Entity
Organization
Contact information
Practice address
450 WEST 5TH PLACE, MESA, AZ 85201
(480) 429-4126
(480) 429-4126
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
251S00000X
Community/Behavioral Health Agency
Primary
BH-3441
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
476231
—
AZ
01
—
BH-3441
OBHL LICENSE
AZ
Enumeration date
11/04/2009
Last updated
02/01/2010
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