Provider Demographics
NPI:1639328263
Name:DISCOVERY RANCH
Entity Type:Organization
Organization Name:DISCOVERY RANCH
Other - Org Name:DISCOVERY RANCH
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:
Authorized Official - Last Name:DORNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-489-3311
Mailing Address - Street 1:757 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-2452
Mailing Address - Country:US
Mailing Address - Phone:801-491-2270
Mailing Address - Fax:801-704-2001
Practice Address - Street 1:1308 S 1600 W
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:UT
Practice Address - Zip Code:84664-4221
Practice Address - Country:US
Practice Address - Phone:801-489-3311
Practice Address - Fax:801-491-2279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14273322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children