| Red Rock Family Services Llc | |
|
707 E Mingus Ave Ste 400 Cottonwood AZ 86326-3746 | |
| (928) 649-0447 | |
| (928) 350-6417 |
| Full Name | Red Rock Family Services Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 707 E Mingus Ave Ste 400, Cottonwood, Arizona |
| Authorized Official Name and Position | Leslie Wade King (CEO) |
| Authorized Official Contact | 8324512628 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Red Rock Family Services Llc 707 E Mingus Ave Ste 400 Cottonwood AZ 86326-3746 Ph: (928) 649-0447 | Red Rock Family Services Llc 707 E Mingus Ave Ste 400 Cottonwood AZ 86326-3746 Ph: (928) 649-0447 |
| NPI Number | 1215568324 |
|---|---|
| Provider Enumeration Date | 01/28/2020 |
| Last Update Date | 10/23/2023 |
| Certification Date | 05/12/2022 |
| Medicare PECOS PAC ID | 4486099660 |
|---|---|
| Medicare Enrollment ID | O20240227003690 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215568324 | NPI | - | NPPES |
| 1215568324 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Leslie Wade King |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1679642615 PECOS PAC ID: 9335052406 Enrollment ID: I20240228003642 |
| Provider Name | Michael King |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1801104336 PECOS PAC ID: 9830534015 Enrollment ID: I20240301000622 |
| Provider Name | Karen Marzullo |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1427558634 PECOS PAC ID: 5597100461 Enrollment ID: I20240301000698 |
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