Healthcare Provider Details

I. General information

NPI: 1194409433
Provider Name (Legal Business Name): IN BALANCE RANCH ACADEMY , INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3331 N IN BALANCE RD
HUACHUCA CITY AZ
85616-8318
US

IV. Provider business mailing address

6107 E GRANT RD
TUCSON AZ
85712-5828
US

V. Phone/Fax

Practice location:
  • Phone: 207-505-0143
  • Fax:
Mailing address:
  • Phone: 520-722-9631
  • Fax: 520-722-9676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: SHARON REYNOLDS
Title or Position: EXEC ADMIN DIRECTOR
Credential:
Phone: 207-505-0143