Provider Demographics
NPI:1508506551
Name:THE MEADOWS RANCH OUTPATIENT CENTER LLC
Entity Type:Organization
Organization Name:THE MEADOWS RANCH OUTPATIENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF REVENUE CYCLE MANAGEMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-256-3020
Mailing Address - Street 1:19820 N 7TH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-1694
Mailing Address - Country:US
Mailing Address - Phone:928-684-4039
Mailing Address - Fax:
Practice Address - Street 1:1901 GOLD NUGGET LANE
Practice Address - Street 2:MOUNTAIN VIEW BUILDING
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-4358
Practice Address - Country:US
Practice Address - Phone:602-256-3020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-29
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder