Healthcare Provider Details

I. General information

NPI: 1033497276
Provider Name (Legal Business Name): ARIVACA RANCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38000 SOUTH ARIVACA RANCH ROAD
ARIVACA AZ
85601
US

IV. Provider business mailing address

PO BOX 547
ARIVACA AZ
85601-0547
US

V. Phone/Fax

Practice location:
  • Phone: 877-886-9766
  • Fax: 866-458-4492
Mailing address:
  • Phone: 877-886-9766
  • Fax: 866-458-4492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License NumberBH-3035
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberBH-3035
License Number StateAZ

VIII. Authorized Official

Name: RONALD P SEARLE
Title or Position: OWNER
Credential:
Phone: 480-216-8982