Provider Demographics
NPI:1578277737
Name:WARDOG RANCH REINS OF CHANGE
Entity Type:Organization
Organization Name:WARDOG RANCH REINS OF CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WARFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-449-0367
Mailing Address - Street 1:313 E ABRIENDO AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-4212
Mailing Address - Country:US
Mailing Address - Phone:760-449-0367
Mailing Address - Fax:
Practice Address - Street 1:313 E ABRIENDO AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-4212
Practice Address - Country:US
Practice Address - Phone:760-449-0367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities