Provider Demographics
NPI:1225718307
Name:DR. PHAETRA K. RANEY FOUNDATION , INC
Entity Type:Organization
Organization Name:DR. PHAETRA K. RANEY FOUNDATION , INC
Other - Org Name:DAMASCUS LANDING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PHAETRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-363-7877
Mailing Address - Street 1:19901 SOUTHWEST FWY STE 141
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-6538
Mailing Address - Country:US
Mailing Address - Phone:281-665-7346
Mailing Address - Fax:
Practice Address - Street 1:313 S 5TH ST STE 7
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-2755
Practice Address - Country:US
Practice Address - Phone:832-363-7877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty