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General NPI Number Information
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NPI Number | 1265033922
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Entity Type | Organization
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Legal Business Name | RUBY MOUNTAIN RECOVERY
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Dates
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Enumeration Date | 11/07/2020
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Last Update Date | 11/07/2020
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Provider Practice Location Address
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Address Line | 1009 SILVER ST
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City | ELKO
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State | NV
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Zip | 89801-3936
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Country | US
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Telephone | 775-397-3486
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Fax |
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Provider Business Mailing Address
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Address Line | 600 WESTERN HLS UNIT 16
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City | SPRING CREEK
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State | NV
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Zip | 89815-9722
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Country | US
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Telephone | 775-397-3486
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SIERRA BRADEEN
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Credential |
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Telephone | 775-397-3486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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