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General NPI Number Information
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NPI Number | 1639216393
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Entity Type | Organization
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Legal Business Name | REMUDA RANCH CENTER FOR ANOREXIA AND BULIMIA INC
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 12/08/2015
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Provider Practice Location Address
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Address Line | 1245 JACK BURDEN RD
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City | WICKENBURG
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State | AZ
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Zip | 85390-3370
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Country | US
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Telephone | 928-684-3913
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Fax |
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Provider Business Mailing Address
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Address Line | 19820 N 7TH ST STE 205
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City | PHOENIX
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State | AZ
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Zip | 85024-1694
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Country | US
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Telephone | 928-684-4029
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Fax |
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Authorized Official
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Title or Position | V.P. OF COMPLIANCE
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Name | MRS. ANNE WHISLER
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Credential |
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Telephone | 928-684-4029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 284300000X
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Taxonomy Name | Special Hospital
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License Number | SH5614
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License Number State | AZ
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