Healthcare Provider Details

I. General information

NPI: 1912152356
Provider Name (Legal Business Name): REMUDA RANCH CENTER FOR EATING DISORDERS EAST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2008
Last Update Date: 11/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 NORTH MAIN STREET
BOWLING GREEN VA
22427
US

IV. Provider business mailing address

1 E APACHE ST
WICKENBURG AZ
85390-2442
US

V. Phone/Fax

Practice location:
  • Phone: 804-632-1090
  • Fax:
Mailing address:
  • Phone: 804-632-1090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number935-02-019
License Number StateVA

VIII. Authorized Official

Name: MS. JULIE KESTNER
Title or Position: CFO / SR. VP
Credential:
Phone: 928-684-3913