Healthcare Provider Details

I. General information

NPI: 1861338246
Provider Name (Legal Business Name): RANCHO BELLA FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21609 N 12TH AVE STE 600B
PHOENIX AZ
85027-2836
US

IV. Provider business mailing address

21609 N 12TH AVE STE 600B
PHOENIX AZ
85027-2836
US

V. Phone/Fax

Practice location:
  • Phone: 602-622-7731
  • Fax:
Mailing address:
  • Phone: 602-622-7731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JACK REIGELSPERGER
Title or Position: FOUNDER
Credential:
Phone: 602-622-7731