Seaglass Az LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

SEAGLASS AZ LLC

Doing business as

Seaglass Recovery

Practice address

711 W Gurley St
Prescott, AZ 86305-3621

Phone

(855) 468-3369

NPI assigned

Jan 17, 2022

Organization subpart

No

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

Authorized official

Name

Shandalee Jackson

Title

Credentialing Manager

Phone

(561) 562-6271

Specialties & licenses 1

Addresses

Other names 1

• Seaglass Recovery Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Royal Life Centers2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Seaglass Az LLC

  dba Royal Life Centers

  • Substance Abuse Rehabilitation Facility
  • Prescott, AZ
  • NPI 1003567207
  NPD tax ID

Locations

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

{
    "created_epoch": "1642377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647907200000",
    "number": "1710638226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1590 S CONGRESS AVE",
            "city": "PALM SPRINGS",
            "state": "FL",
            "postal_code": "334065957",
            "telephone_number": "347-693-4239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 W GURLEY ST",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863053621",
            "telephone_number": "855-468-3369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEAGLASS AZ LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-17",
        "last_updated": "2022-03-22",
        "certification_date": "2022-03-22",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "SHANDALEE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "561-562-6271"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Seaglass Recovery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Seaglass Recovery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sigrid E Schwartz, D.D.S., M.S.D.
• Karen L Schwieter, RD
• Linda Jean Scott, M.AC.
• Scottsdale Heart Health & Wellness PLLC (Healthfinity of Northern Arizona)
• Seaglass Az LLC (Royal Life Centers)
• Seaglass Recovery
• Seaglass Recovery
• Erin Sears, FNP-BC
• Teri Sebastian, LMFT, LISAC
• Marc M. Sedwitz, M.D.

• Substance Use Disorder Rehabilitation Clinic/Center in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.