Provider Demographics
NPI:1912152356
Name:REMUDA RANCH CENTER FOR EATING DISORDERS EAST, INC.
Entity Type:Organization
Organization Name:REMUDA RANCH CENTER FOR EATING DISORDERS EAST, INC.
Other - Org Name:REMUDA LIFE PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO / SR. VP
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KESTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-684-3913
Mailing Address - Street 1:1 E APACHE ST
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-2442
Mailing Address - Country:US
Mailing Address - Phone:804-632-1090
Mailing Address - Fax:
Practice Address - Street 1:124 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:VA
Practice Address - Zip Code:22427
Practice Address - Country:US
Practice Address - Phone:804-632-1090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REMUDA RANCH HOLDING COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA935-02-019323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility