| NPI | 1588740930 |
|---|---|
| Former Legal Business Name | SEQUELCARE OF ARIZONA, LLC DBA SMOKI TRAIL |
| Entity Type | Organization |
| Authorized Contact | BROOKE WILSON Senior Credentialing Specialist 928-910-7644 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: AZ BH-2163) |
| Enumeration Date | 2006-10-28 |
| Last Update Date | 2022-07-06 |