Provider Demographics
NPI:1609198571
Name:LAZY HORSE RANCH INC
Entity Type:Organization
Organization Name:LAZY HORSE RANCH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SUPPLEE
Authorized Official - Suffix:
Authorized Official - Credentials:BHT
Authorized Official - Phone:520-826-2206
Mailing Address - Street 1:3651 E DOE RANCH RD
Mailing Address - Street 2:
Mailing Address - City:PEARCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85625-6002
Mailing Address - Country:US
Mailing Address - Phone:520-826-2206
Mailing Address - Fax:
Practice Address - Street 1:675 GIULIO CESARE AVE
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2564
Practice Address - Country:US
Practice Address - Phone:520-826-2206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCSA09ADHS0188251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health