Provider Demographics
NPI:1811357767
Name:NEW HORIZON'S YOUTH RANCH
Entity type:Organization
Organization Name:NEW HORIZON'S YOUTH RANCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOE
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-889-5994
Mailing Address - Street 1:5677 W KOOTENAI RD
Mailing Address - Street 2:
Mailing Address - City:REXFORD
Mailing Address - State:MT
Mailing Address - Zip Code:59930-9750
Mailing Address - Country:US
Mailing Address - Phone:406-889-5994
Mailing Address - Fax:
Practice Address - Street 1:6442 W KOOTENAI RD
Practice Address - Street 2:
Practice Address - City:REXFORD
Practice Address - State:MT
Practice Address - Zip Code:59930-9440
Practice Address - Country:US
Practice Address - Phone:406-889-5995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTD129596320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness