Healthcare Provider Details

I. General information

NPI: 1659560803
Provider Name (Legal Business Name): REMUDA RANCH RLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55635 N VULTURE MINE RD
WICKENBURG AZ
85390-4358
US

IV. Provider business mailing address

19820 N 7TH ST STE 205
PHOENIX AZ
85024-1694
US

V. Phone/Fax

Practice location:
  • Phone: 928-684-3913
  • Fax:
Mailing address:
  • Phone: 928-684-4029
  • Fax: 928-684-4567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberIFBH6963
License Number StateAZ

VIII. Authorized Official

Name: MS. ANNE WHISLER
Title or Position: V.P. OF COMPLIANCE
Credential:
Phone: 928-684-4029