Provider Demographics
NPI:1912067935
Name:RAINDANCER YOUTH SERVICES, INC.
Entity Type:Organization
Organization Name:RAINDANCER YOUTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLLAHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-656-1020
Mailing Address - Street 1:PO BOX 910400
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84791-0400
Mailing Address - Country:US
Mailing Address - Phone:435-656-1020
Mailing Address - Fax:435-673-6477
Practice Address - Street 1:37 W 1070 S
Practice Address - Street 2:SUITE 201
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5280
Practice Address - Country:US
Practice Address - Phone:435-656-1020
Practice Address - Fax:435-673-6477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM61005070251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM61005070Medicaid