Provider Demographics
NPI:1346766953
Name:RITE OF PASSAGE, INC.
Entity Type:Organization
Organization Name:RITE OF PASSAGE, INC.
Other - Org Name:CANYON STATE ACADEMY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RUSTY
Authorized Official - Middle Name:E
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-392-2639
Mailing Address - Street 1:20275 E RITTENHOUSE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-1661
Mailing Address - Country:US
Mailing Address - Phone:480-987-2053
Mailing Address - Fax:
Practice Address - Street 1:20061 E RITTENHOUSE RD
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-9715
Practice Address - Country:US
Practice Address - Phone:480-987-2047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RITE OF PASSAGE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCSLG6685261QM0855X
322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health