Provider Demographics
NPI:1669170379
Name:WILDFLOWER MOUNTAIN RANCH INC
Entity type:Organization
Organization Name:WILDFLOWER MOUNTAIN RANCH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:KASPRZAK-BRATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:CMHC
Authorized Official - Phone:479-222-8462
Mailing Address - Street 1:1075 S 6800 E
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84317-9724
Mailing Address - Country:US
Mailing Address - Phone:479-222-8462
Mailing Address - Fax:
Practice Address - Street 1:2841 N NORDIC VALLEY DR
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:UT
Practice Address - Zip Code:84310-6853
Practice Address - Country:US
Practice Address - Phone:801-835-9359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children