Re-Creation Retreat LLC

NPI #1629339437 in Fredonia, Arizona

Provider Information

NPI Number: 1629339437
Entity Type: Organization
Organization Name: Re-Creation Retreat LLC
Primary Specialty: Community Based Residential Treatment Facility, Mental Illness
Enumeration Date: Jun 7, 2012
Last Updated: Nov 21, 2012

Practice Location

Address: 455 SOUTH MAIN
City: Fredonia
State: Arizona
ZIP Code: 86022
Phone: (435) 691-0856

Authorized Official

Name: MR. RANDY K SODERQUIST, LCSW
Title: OWNER AND CLINICAL DIRECTOR
Phone: (435) 691-0856

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Substance Abuse Rehabilitation Facility	324500000X
Community Based Residential Treatment Facility, Mental Illness	320800000X	Primary

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