Healthcare Provider Details

I. General information

NPI: 1821916958
Provider Name (Legal Business Name): ANTORA YOUTH RANCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9230 6400 RD
MONTROSE CO
81401-8200
US

IV. Provider business mailing address

9230 6400 RD
MONTROSE CO
81401-8200
US

V. Phone/Fax

Practice location:
  • Phone: 970-640-5765
  • Fax:
Mailing address:
  • Phone: 970-640-5765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LEANE OLIVER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 970-640-5765