RE-CREATION RETREAT LLC – NPI #1629339437
Community Based Residential Treatment Facility, Mental Illness

A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.

RE-CREATION RETREAT LLC is a community based residential treatment facility located in FREDONIA, AZ. NPPES has assigned the NPI number 1629339437 to RE-CREATION RETREAT LLC on June 07, 2012. It is a Type-2 NPI, indicating this NPI number is associated with an organization. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 320800000X from the Health Care Provider Taxonomy code set, which is classified as Community Based Residential Treatment Facility, Mental Illness.

The NPI profile was previously updated about 14 years ago on Nov 21, 2012. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for RE-CREATION RETREAT LLC below.

NPI Profile for
RE-CREATION RETREAT LLC

NPI Number
1629339437
Enumeration Date

(about 14 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
RE-CREATION RETREAT LLC
Primary location
455 SOUTH MAIN
FREDONIA, AZ 86022
Phone: (435) 691-0856 Fax:
Mailing address
380 W LOS BARANCOS LN
P.O. BOX 61
KANAB, UT 84741-3311
Phone: (435) 691-0856 Fax:
Organization Subpart
No
Authorized Official
RANDY SODERQUIST
OWNER AND CLINICAL DIRECTOR
Phone: (435) 691-0856
Updated
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
320800000X
- Community Based Residential Treatment Facility, Mental Illness (Primary)
AZ BH-3895
324500000X
- Substance Abuse Rehabilitation Facility
AZ BH-3895

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.