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General NPI Number Information
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NPI Number | 1346766953
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Entity Type | Organization
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Legal Business Name | RITE OF PASSAGE, INC.
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Dates
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Enumeration Date | 08/15/2017
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Last Update Date | 03/15/2024
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Provider Practice Location Address
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Address Line | 20061 E RITTENHOUSE RD
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-9715
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Country | US
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Telephone | 480-987-2047
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Fax |
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Provider Business Mailing Address
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Address Line | 20275 E RITTENHOUSE RD STE 105
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-1661
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Country | US
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Telephone | 480-987-2053
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGING DIRECTOR
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Name | RUSTY E. ALEXANDER
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Credential |
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Telephone | 775-392-2639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | CSLG6685
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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