| Organization Name: | SEASIDE SANCTUARY CLINIC LLC |
| NPI Number: | 1285784082 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY C MEADOWS (DIRECTOR) |
| Mailing Address: | 2401 W Route 66 #24 Flagstaff |
| State: | AZ US |
| Postal Code: | 860018761 |
| Phone Number: | 3614631353 |
| Fax Number: | 2152610666 |
| NPI Enumeration Date: | 01/12/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | K6250 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |