Provider Demographics
NPI:1114620051
Name:CASTLE RIDGE BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:CASTLE RIDGE BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONN
Authorized Official - Middle Name:VEE
Authorized Official - Last Name:JEFFS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-749-1484
Mailing Address - Street 1:PO BOX 263
Mailing Address - Street 2:
Mailing Address - City:CASTLE DALE
Mailing Address - State:UT
Mailing Address - Zip Code:84513-0263
Mailing Address - Country:US
Mailing Address - Phone:435-749-5425
Mailing Address - Fax:
Practice Address - Street 1:55 E 100 N
Practice Address - Street 2:
Practice Address - City:CASTLE DALE
Practice Address - State:UT
Practice Address - Zip Code:84513-8451
Practice Address - Country:US
Practice Address - Phone:435-749-5425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health