Provider Demographics
NPI:1265033922
Name:RUBY MOUNTAIN RECOVERY
Entity Type:Organization
Organization Name:RUBY MOUNTAIN RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIERRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-397-3486
Mailing Address - Street 1:600 WESTERN HLS UNIT 16
Mailing Address - Street 2:
Mailing Address - City:SPRING CREEK
Mailing Address - State:NV
Mailing Address - Zip Code:89815-9722
Mailing Address - Country:US
Mailing Address - Phone:775-397-3486
Mailing Address - Fax:
Practice Address - Street 1:1009 SILVER ST
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-3936
Practice Address - Country:US
Practice Address - Phone:775-397-3486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-07
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty