Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Health Service |
261QH0100X | |||
Infusion Therapy |
261QI0500X | |||
Naturopath |
175F00000X | |||
Substance Abuse Disorder Rehabilitation Facility |
324500000X |
| NPI # | 1780084236 |
| LBN Legal business name | LODGE AT SEDONA, LLC |
| Authorized official | RYAN FERCHOFF - (DIRECTOR) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 09/02/2014 |
| Last updated | 09/02/2014 - About 12 years ago |
| Identifiers | n/a |
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LODGE AT SEDONA, LLC
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