NPIMap

Organization Active NPI

Lodge at Sedona, LLC

  • Health Service Clinic/Center
  • Sedona, AZ
National Provider Identifier
1780084236
Registry record updated Sep 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
LODGE AT SEDONA, LLC
Practice address
125 Kallof PL
Lodge at Sedona
Sedona, AZ 86336-5566
Phone
(928) 204-1942
Fax
(928) 204-2128
NPI assigned
Sep 2, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2014

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

Authorized official

Name
Ryan Ferchoff, N.M.D.
Title
Director
Phone
(928) 613-2233

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
NaturopathGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 175F00000X
Health Service Clinic/Center 261QH0100X Primary
Infusion Therapy Clinic/Center 261QI0500X
Substance Abuse Rehabilitation Facility 324500000X

Addresses

Primary practice location

125 Kallof PL
Lodge at Sedona
Sedona, AZ 86336-5566

Mailing address

125 Kallof PL
Lodge at Sedona
Sedona, AZ 86336-5566
Phone (928) 204-1942

Other names 1

  • Sedona Wellness Retreat Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2139869Sedona Wellness Retreat125 Kallof PL, Sedona, AZ 86336Certificate of waiverNov 8, 2027

National Provider Directory

National Provider Directory

Locations

125 Kallof Pl
Sedona, AZ 86336
Phone (928) 204-1942

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1409616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409616000000",
    "number": "1780084236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 KALLOF PL",
            "address_2": "LODGE AT SEDONA",
            "city": "SEDONA",
            "state": "AZ",
            "postal_code": "863365566",
            "telephone_number": "928-204-1942",
            "fax_number": "928-204-2128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 KALLOF PL",
            "address_2": "LODGE AT SEDONA",
            "city": "SEDONA",
            "state": "AZ",
            "postal_code": "863365566",
            "telephone_number": "928-204-1942",
            "fax_number": "928-204-2128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LODGE AT SEDONA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-02",
        "last_updated": "2014-09-02",
        "status": "A",
        "authorized_official_last_name": "FERCHOFF",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "928-613-2233",
        "authorized_official_credential": "N.M.D."
    },
    "taxonomies": [
        {
            "code": "175F00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Naturopath",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sedona Wellness Retreat",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sedona, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2014; 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.