Provider Demographics
NPI:1235665472
Name:RITE OF PASSAGE INC
Entity Type:Organization
Organization Name:RITE OF PASSAGE INC
Other - Org Name:RIDGEVIEW YOUTH SERVICE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:LEAD A/R CLERK
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRANDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-392-2657
Mailing Address - Street 1:2560 BUSINESS PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-8985
Mailing Address - Country:US
Mailing Address - Phone:775-392-2657
Mailing Address - Fax:775-392-2455
Practice Address - Street 1:28101 E QUINCY AVE
Practice Address - Street 2:
Practice Address - City:WATKINS
Practice Address - State:CO
Practice Address - Zip Code:80137-9502
Practice Address - Country:US
Practice Address - Phone:303-766-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-09
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty