Provider Demographics
NPI:1548500614
Name:FALCON RIDGE RANCH NON PROFIT ORGANIZATION
Entity type:Organization
Organization Name:FALCON RIDGE RANCH NON PROFIT ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
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:PO BOX 790099
Mailing Address - Street 2:
Mailing Address - City:VIRGIN
Mailing Address - State:UT
Mailing Address - Zip Code:84779-0099
Mailing Address - Country:US
Mailing Address - Phone:435-635-5260
Mailing Address - Fax:435-673-0994
Practice Address - Street 1:633 E HWY 9
Practice Address - Street 2:
Practice Address - City:VIRGIN
Practice Address - State:UT
Practice Address - Zip Code:84779
Practice Address - Country:US
Practice Address - Phone:435-635-5260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-26
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT200043245S0500X, 323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children