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NPI Code Detail

MEDICARE: ST. JUDE'S RANCH FOR CHILDREN

MEDICARE: ST. JUDE'S RANCH FOR CHILDREN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790089209
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. JUDE'S RANCH FOR CHILDREN
Provider Business Mailing Address
First Line : PO BOX 60100
Second Line :
City : BOULDER CITY
State : NV
Zip : 89006-0100
Country : US
Telephone Number : 702-294-7100
Fax Number : 702-294-7171
Provider Business Practice Location Address
First Line : 100 SAINT JUDES ST
Second Line :
City : BOULDER CITY
State : NV
Zip : 89005-1614
Country : US
Telephone Number : 702-294-7100
Fax Number : 702-294-7171
Authorized Official
Title or Position : CLINICAL DIRECTOR
Name : MRS. HANNAH L WARE
Credential : LMFT
Telephone Number : 702-294-7135
Provider Enumeration Date : 12/28/2010
Last Update Date : 08/01/2014

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Directions to “ST. JUDE'S RANCH FOR CHILDREN ” Practice Location

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