Provider Demographics
NPI:1891963161
Name:COURAGE TO CHANGE RANCHES
Entity Type:Organization
Organization Name:COURAGE TO CHANGE RANCHES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:719-541-4912
Mailing Address - Street 1:41250 ALFORD RD
Mailing Address - Street 2:
Mailing Address - City:SIMLA
Mailing Address - State:CO
Mailing Address - Zip Code:80835-9607
Mailing Address - Country:US
Mailing Address - Phone:719-541-4912
Mailing Address - Fax:719-541-4911
Practice Address - Street 1:41250 ALFORD RD
Practice Address - Street 2:
Practice Address - City:SIMLA
Practice Address - State:CO
Practice Address - Zip Code:80835-9607
Practice Address - Country:US
Practice Address - Phone:719-541-4912
Practice Address - Fax:719-541-4911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COADAD 251S00000X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health