Provider Demographics
NPI:1003014648
Name:EAGLE RANCH ACADEMY
Entity Type:Organization
Organization Name:EAGLE RANCH ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARSLANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-652-8488
Mailing Address - Street 1:115 W 1470 S
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-6763
Mailing Address - Country:US
Mailing Address - Phone:435-652-8488
Mailing Address - Fax:435-652-9959
Practice Address - Street 1:115 W 1470 S
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-6763
Practice Address - Country:US
Practice Address - Phone:435-652-8488
Practice Address - Fax:435-652-9959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT127533245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children