Healthcare Provider Details

I. General information

NPI: 1275327454
Provider Name (Legal Business Name): IN BALANCE RANCH ACADEMY , INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 04/04/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 N IN BALANCE ROAD
HUACHUCA CITY AZ
85712
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 TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

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