Provider Demographics
NPI:1659560803
Name:REMUDA RANCH RLP
Entity Type:Organization
Organization Name:REMUDA RANCH RLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P. OF COMPLIANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHISLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-684-4029
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:928-684-4029
Mailing Address - Fax:928-684-4567
Practice Address - Street 1:55635 N VULTURE MINE RD
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-4358
Practice Address - Country:US
Practice Address - Phone:928-684-3913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REMUDA RANCH HOLDING COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-23
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZIFBH6963323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility