Provider Demographics
NPI:1366694713
Name:BLUE CHERRIES LLC
Entity Type:Organization
Organization Name:BLUE CHERRIES LLC
Other - Org Name:WHITE PINE BOYS RANCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:P
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-735-5971
Mailing Address - Street 1:PO BOX 235
Mailing Address - Street 2:
Mailing Address - City:LUND
Mailing Address - State:NV
Mailing Address - Zip Code:89317-0235
Mailing Address - Country:US
Mailing Address - Phone:702-430-6206
Mailing Address - Fax:801-756-1862
Practice Address - Street 1:6479 WEST 317 NORTH
Practice Address - Street 2:
Practice Address - City:LUND
Practice Address - State:NV
Practice Address - Zip Code:89317-0235
Practice Address - Country:US
Practice Address - Phone:702-430-6206
Practice Address - Fax:801-763-1852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4790345-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty