Healthcare Provider Details

I. General information

NPI: 1699091710
Provider Name (Legal Business Name): SPRING RIDGE ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13690 S. BURTON RD.
SPRING VALLEY AZ
86333
US

IV. Provider business mailing address

13690 S. BURTON RD.
SPRING VALLEY AZ
86333
US

V. Phone/Fax

Practice location:
  • Phone: 928-632-4602
  • Fax: 928-632-7661
Mailing address:
  • Phone: 928-632-4602
  • Fax: 928-632-7661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberBH1721
License Number StateAZ

VIII. Authorized Official

Name: SUZANNE COURTNEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 928-925-5965