Provider Demographics
NPI:1942621768
Name:ARROWHEAD RANCH INC.
Entity Type:Organization
Organization Name:ARROWHEAD RANCH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:309-799-7044
Mailing Address - Street 1:12228 104TH ST
Mailing Address - Street 2:P.O. BOX 370
Mailing Address - City:COAL VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61240-9712
Mailing Address - Country:US
Mailing Address - Phone:309-799-7044
Mailing Address - Fax:309-799-7090
Practice Address - Street 1:12228 104TH ST
Practice Address - Street 2:
Practice Address - City:COAL VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61240-9712
Practice Address - Country:US
Practice Address - Phone:309-799-7044
Practice Address - Fax:309-799-7090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL001583-11322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children