Organization
SEQUELCARE OF ARIZONA
Active
Organization
SEQUELCARE OF ARIZONA
Active
Other names
Tap Program Outpatient Clinic - Tempe
Organization subpart
No
Provider details
NPI number
Authorized official
WENDY RAZO (EXECUTIVE DIRECTOR)
(928) 777-3280
Entity
Organization
Contact information
Practice address
2020 S MCCLINTOCK DRIVE SUITE 105, TEMPE, AZ 85282
(480) 284-7304
(480) 284-7616
Mailing address
3170 STILLWATER DRIVE, PRESCOTT, AZ 86305
(928) 777-3280
(928) 717-1660
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
BH-3420
AZ
251S00000X
Community/Behavioral Health Agency
Primary
OTC8667
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
476196
—
AZ
01
—
BH-3420
AHCCCS
AZ
01
—
OTC8667
OUTPATIENT TREATMENT CENTER
AZ
Enumeration date
10/27/2009
Last updated
03/07/2018
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