Provider Demographics
NPI:1033497276
Name:ARIVACA RANCH LLC
Entity Type:Organization
Organization Name:ARIVACA RANCH LLC
Other - Org Name:ARIVACA BOYS RANCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:SEARLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-216-8982
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:ARIVACA
Mailing Address - State:AZ
Mailing Address - Zip Code:85601-0547
Mailing Address - Country:US
Mailing Address - Phone:877-886-9766
Mailing Address - Fax:866-458-4492
Practice Address - Street 1:38000 SOUTH ARIVACA RANCH ROAD
Practice Address - Street 2:
Practice Address - City:ARIVACA
Practice Address - State:AZ
Practice Address - Zip Code:85601
Practice Address - Country:US
Practice Address - Phone:877-886-9766
Practice Address - Fax:866-458-4492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-21
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-3035261QM0855X, 3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH-3035OtherARIZONA BEHAVIORAL HEALTH LICENSE
AZ=========OtherEIN - TAX ID