Healthcare Provider Details

I. General information

NPI: 1871639195
Provider Name (Legal Business Name): REMUDA RANCH CENTER FOR EATING DISORDERS EAST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 11/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

REMUDA EAST 20500 EASTER SEALS DR.
MILFORD VA
22514
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: 928-684-3913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JULIE KESTNER
Title or Position: CFO V.P.
Credential:
Phone: 928-684-3913