Provider Demographics
NPI:1720266570
Name:RED ROCK CANYON SCHOOL NON PROFIT ORGANIZATION
Entity Type:Organization
Organization Name:RED ROCK CANYON SCHOOL NON PROFIT ORGANIZATION
Other - Org Name:RED ROCK CANYON SCHOOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:MA ED, MC
Authorized Official - Phone:435-673-6111
Mailing Address - Street 1:747 E SAINT GEORGE BLVD
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3035
Mailing Address - Country:US
Mailing Address - Phone:435-673-6111
Mailing Address - Fax:435-673-0994
Practice Address - Street 1:747 E SAINT GEORGE BLVD
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3035
Practice Address - Country:US
Practice Address - Phone:435-673-6111
Practice Address - Fax:435-673-0994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3648323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM54988322Medicaid
NV100521047Medicaid