Organization
SACRED MOUNTAIN NON-MEDICAL TRANSPORT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TONY D. LILLY (OWNER)
(928) 871-4997
Entity
Organization
Contact information
Practice address
HWY 264 RT 12 SPACE 4, WINDOWROCK, AZ 86515
(928) 871-4997
(928) 871-5008
Mailing address
PO BOX 315, ST MICHAELS, AZ 86511-0315
(928) 871-4997
(928) 871-5008
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
AZ
Other
Enumeration date
02/10/2010
Last updated
02/10/2010
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