Provider Demographics
NPI:1629428503
Name:WITS END RANCH RETREAT
Entity Type:Organization
Organization Name:WITS END RANCH RETREAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-749-6126
Mailing Address - Street 1:254 COUNTY ROAD 500
Mailing Address - Street 2:
Mailing Address - City:BAYFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81122-8721
Mailing Address - Country:US
Mailing Address - Phone:970-749-6216
Mailing Address - Fax:970-884-2327
Practice Address - Street 1:254 COUNTY ROAD 500
Practice Address - Street 2:
Practice Address - City:BAYFIELD
Practice Address - State:CO
Practice Address - Zip Code:81122-8721
Practice Address - Country:US
Practice Address - Phone:970-749-6216
Practice Address - Fax:970-884-2327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility