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General NPI Number Information
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NPI Number | 1275327454
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Entity Type | Organization
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Legal Business Name | IN BALANCE RANCH ACADEMY , INC.
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Dates
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Enumeration Date | 04/04/2025
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 3333 N IN BALANCE ROAD
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City | HUACHUCA CITY
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State | AZ
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Zip | 85712
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Country | US
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Telephone | 520-722-9631
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Fax |
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Provider Business Mailing Address
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Address Line | 6107 E GRANT RD
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City | TUCSON
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State | AZ
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Zip | 85712-5828
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Country | US
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Telephone | 520-722-9631
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Fax |
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Authorized Official
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Title or Position | COO
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Name | ANTHONY BARRASSO
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Credential | MPA, MLS
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Telephone | 520-722-9631
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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