Organization
SACRED MOUNTAIN HOME CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TONY DERALD LILLY (CEO)
(505) 612-9119
Entity
Organization
Contact information
Practice address
2 MILES WEST OF DAYS INN ON HWY 264, ST. MICHAELS, AZ 86511-0315
(505) 612-9119
Mailing address
PO BOX 315, ST MICHAELS, AZ 86511-0315
(505) 612-9119
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
04/16/2009
Last updated
04/16/2009
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