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General NPI Number Information
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NPI Number | 1811357767
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Entity Type | Organization
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Legal Business Name | NEW HORIZON'S YOUTH RANCH
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Dates
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Enumeration Date | 03/03/2016
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Last Update Date | 03/03/2016
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Provider Practice Location Address
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Address Line | 6442 W KOOTENAI RD
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City | REXFORD
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State | MT
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Zip | 59930-9440
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Country | US
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Telephone | 406-889-5995
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Fax |
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Provider Business Mailing Address
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Address Line | 5677 W KOOTENAI RD
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City | REXFORD
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State | MT
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Zip | 59930-9750
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Country | US
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Telephone | 406-889-5994
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Fax |
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Authorized Official
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Title or Position | DIRECTOE
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Name | MR. THOMAS EUGENE HARRELL
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Credential |
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Telephone | 406-889-5994
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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 | D129596
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License Number State | MT
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