Re-Creation Retreat LLC

Organization Mental Illness Community Based Residential Treatment Facility · NPI 1629339437

Re-Creation Retreat LLC is a Mental Illness Community Based Residential Treatment Facility in Fredonia, Arizona. Licensed in Arizona. Registered with an NPI since 2012.

Licensed in: AZ
In the registry since: 2012
Specialties on file: 2

What do these letters mean?

LLC — Limited liability company: A form of business registration, not a clinical qualification.

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Practice location Address checks out

455 S Main
Fredonia, AZ 86022
Phone: (435) 691-0856

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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Illness Community Based Residential Treatment Facility (primary)	Taxonomy 320800000X · Licence BH-3895 (AZ)
Substance Abuse Rehabilitation Facility	Taxonomy 324500000X · Licence BH-3895 (AZ)

Record details

NPI number	1629339437
Entity type	Organization (Type 2)
Organization subpart	No
Authorized official	Randy Soderquist — Owner And Clinical Director · (435) 691-0856
NPI enumerated	June 7, 2012
Last updated in NPPES	November 21, 2012
Mailing address	380 W Los Barancos Ln, P.O. Box 61, Kanab, UT 84741-3311