Healthcare Provider Details

I. General information

NPI: 1285889873
Provider Name (Legal Business Name): FALCON RIDGE RANCH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 06/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 E HWY 9
VIRGIN UT
84779
US

IV. Provider business mailing address

747 E SAINT GEORGE BLVD
ST GEORGE UT
84770-3035
US

V. Phone/Fax

Practice location:
  • Phone: 435-673-6111
  • Fax:
Mailing address:
  • Phone: 435-673-6111
  • Fax: 435-673-0994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number13368
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number13368
License Number StateUT

VIII. Authorized Official

Name: BRIAN PACE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 435-673-6111