Provider Demographics
NPI:1902208804
Name:ASHCREEK RANCH UTAH
Entity Type:Organization
Organization Name:ASHCREEK RANCH UTAH
Other - Org Name:ASHCREEK RANCH ACADEMY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-215-0500
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:TOQUERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84774-0039
Mailing Address - Country:US
Mailing Address - Phone:435-215-0500
Mailing Address - Fax:
Practice Address - Street 1:652 N TOQUERVILLE BLVD
Practice Address - Street 2:
Practice Address - City:TOQUERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84774
Practice Address - Country:US
Practice Address - Phone:435-215-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8256323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility