NPIMap

Organization Active NPI

Rosewood Ranch

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Wickenburg, AZ
National Provider Identifier
1023239159
Registry record updated Apr 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
BH-2495 Issued in AZ
Legal business name
ROSEWOOD RANCH
Practice address
521 W Wickenburg Way
Wickenburg, AZ 85390-5200
Phone
(928) 684-8981
Fax
(928) 684-9562
NPI assigned
May 2, 2007
Reactivated
Mar 25, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tyeast Reynolds
Title
Director of RCM
Phone
(678) 813-0428

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X BH-2495 AZ Primary

Addresses

Primary practice location

521 W Wickenburg Way
Wickenburg, AZ 85390-5200

Mailing address

2300 Windy Ridge Pkwy SE Ste 210
Atlanta, GA 30339-5665
Phone (470) 440-1647

Other identifiers 1

IdentifierTypeStateIssuer
AZ0205580OtherAZBCBS OF AZ

National Provider Directory

National Provider Directory
Tax ID family
Rosewood Ranch LP5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

521 W Wickenburg Way
Wickenburg, AZ 85390
Phone (928) 684-8981

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554940800000",
    "number": "1023239159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 WINDY RIDGE PKWY SE STE 210",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303395665",
            "telephone_number": "470-440-1647",
            "fax_number": "470-440-1647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 W WICKENBURG WAY",
            "city": "WICKENBURG",
            "state": "AZ",
            "postal_code": "853905200",
            "telephone_number": "928-684-8981",
            "fax_number": "928-684-9562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSEWOOD RANCH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-02",
        "last_updated": "2019-04-11",
        "deactivation_date": "2017-12-14",
        "reactivation_date": "2019-03-25",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "TYEAST",
        "authorized_official_title_or_position": "DIRECTOR OF RCM",
        "authorized_official_telephone_number": "678-813-0428"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "AZ",
            "license": "BH-2495",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF AZ",
            "identifier": "AZ0205580",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wickenburg, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.