Provider Demographics
NPI:1063827749
Name:KW LEGACY RANCH, LLC
Entity Type:Organization
Organization Name:KW LEGACY RANCH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:HATCH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:775-725-3900
Mailing Address - Street 1:HC 61 BOX 87
Mailing Address - Street 2:
Mailing Address - City:HIKO
Mailing Address - State:NV
Mailing Address - Zip Code:89017-9635
Mailing Address - Country:US
Mailing Address - Phone:775-725-3900
Mailing Address - Fax:775-725-3925
Practice Address - Street 1:1760 SR 318
Practice Address - Street 2:
Practice Address - City:HIKO
Practice Address - State:NV
Practice Address - Zip Code:89017-2215
Practice Address - Country:US
Practice Address - Phone:775-725-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-21
Last Update Date:2014-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility