Organization
SEQUELCARE OF ARIZONA, LLC
Active
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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