Sacred Mountain Home Care

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

SACRED MOUNTAIN HOME CARE

Practice address

2 Miles West of Days Inn on Hwy 264
St. Michaels, AZ 86511-0315

Phone

(505) 612-9119

NPI assigned

Apr 16, 2009

Organization subpart

No

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

Authorized official

Name

Mr. Tony Derald Lilly

Title

Ceo

Phone

(505) 612-9119

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1239840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239840000000",
    "number": "1700029022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 315",
            "city": "ST MICHAELS",
            "state": "AZ",
            "postal_code": "865110315",
            "telephone_number": "505-612-9119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 MILES WEST OF DAYS INN ON HWY 264",
            "city": "ST. MICHAELS",
            "state": "AZ",
            "postal_code": "865110315",
            "telephone_number": "505-612-9119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SACRED MOUNTAIN HOME CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-16",
        "last_updated": "2009-04-16",
        "status": "A",
        "authorized_official_last_name": "LILLY",
        "authorized_official_first_name": "TONY",
        "authorized_official_middle_name": "DERALD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "505-612-9119",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erica Lynn Kish, PT, MPT
• Northern Apache County Special Health Care District
• Northern Apache County Special Health Care District
• Northern Apache County Special Health Care District
• Professional Behavioral Health Services of St. Michaels
• Sacred Sun Transport
• Sequel Tsi of Az, LLC
• St. Michaels Association for Special Education
• Dolores Arlt Sullivan, SLP
• Terricena Ajramirez

• Home Health Agency in St. Michaels, AZ
• Providers in St. Michaels, AZ by specialty
• Home Health Agency in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2009; 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.