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RE-CREATION RETREAT LLC
NPI 1629339437
Community Based Residential Treatment Facility, Mental Illness in Fredonia, AZ

Active since June 07, 2012
455 SOUTH MAIN, FREDONIA, AZ 86022(435) 691-0856 Get Directions Write a Review

NPPES record last updated: November 21, 2012. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Re-creation Retreat Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

RE-CREATION RETREAT LLC (NPI 1629339437) is a healthcare organization registered as a community based residential treatment facility, mental illness in Fredonia, Arizona and active in the NPI registry since June 2012. The organization lists Randy K Soderquist, Owner And Clinical Director, as its authorized official.

NPPES Registry Identity

NPI1629339437
Entity TypeOrganization
Primary Taxonomy320800000X
Legal Business NameRE-CREATION RETREAT LLC
Location Address455 SOUTH MAINFredonia, AZ 86022
Mailing Address380 W Los Barancos Ln, P.o. Box 61Kanab, UT 84741-3311 · (435) 691-0856
Phone(435) 691-0856
Organization SubpartNo
Authorized OfficialRandy K SoderquistOwner And Clinical Director · (435) 691-0856
Enumeration DateJune 7, 2012
Last NPPES UpdateNovember 21, 2012
✔ NPI 1629339437 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCommunity Based Residential Treatment Facility, Mental IllnessResidential Treatment Facilities
Taxonomy Code320800000X
License✔ Licensed in AZ · BH-3895
Definition
A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.
Also ListedSubstance Abuse Rehabilitation FacilityTaxonomy 324500000X · License BH-3895 (AZ)
455 SOUTH MAIN, Fredonia, AZ 86022
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Re-Creation Retreat LLC's NPI number?

The NPI number for Re-Creation Retreat LLC is 1629339437. It was assigned to this organization in the NPPES registry on June 7, 2012.

Where is Re-Creation Retreat LLC located?

Re-Creation Retreat LLC is located at 455 South Main, Fredonia, AZ 86022. The listed phone number is (435) 691-0856.

What is Re-Creation Retreat LLC's specialty?

The primary specialty registered for this NPI is Community Based Residential Treatment Facility, Mental Illness with taxonomy code 320800000X.

When was this NPI record last updated?

The NPPES record for Re-Creation Retreat LLC was last updated on November 21, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.