Provider Demographics
NPI:1700205440
Name:HERMITAGE RANCH BEHAVIORAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:HERMITAGE RANCH BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-515-4010
Mailing Address - Street 1:7495 W AZURE DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-4416
Mailing Address - Country:US
Mailing Address - Phone:702-515-4010
Mailing Address - Fax:888-959-8990
Practice Address - Street 1:25772 HERMITAGE RD
Practice Address - Street 2:
Practice Address - City:PIOCHE
Practice Address - State:NV
Practice Address - Zip Code:89043-2597
Practice Address - Country:US
Practice Address - Phone:702-499-7755
Practice Address - Fax:888-959-8990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health