Provider Demographics
NPI:1457497778
Name:REMUDA RANCH CENTER FOR ANOREXIA AND BULIMIA INC
Entity Type:Organization
Organization Name:REMUDA RANCH CENTER FOR ANOREXIA AND BULIMIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO V.P.
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KESTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-684-3913
Mailing Address - Street 1:1 E APACHE ST
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-2442
Mailing Address - Country:US
Mailing Address - Phone:928-684-3913
Mailing Address - Fax:
Practice Address - Street 1:55635 NORTH VULTURE MINE ROAD
Practice Address - Street 2:DEL SOL PROGRAM
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390
Practice Address - Country:US
Practice Address - Phone:928-684-3913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-1945323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility