Healthcare Provider Details

I. General information

NPI: 1487301941
Provider Name (Legal Business Name): IN BALANCE RANCH ACADEMY , INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
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: 520-722-9631
  • Fax:
Mailing address:
  • Phone: 520-722-9631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY BARRASSO
Title or Position: COO
Credential: MPA, MLS
Phone: 520-722-9631