Provider Demographics
NPI:1730560608
Name:TRIANGLE CROSS RANCH
Entity type:Organization
Organization Name:TRIANGLE CROSS RANCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:POLLARD
Authorized Official - Last Name:MORSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-254-4191
Mailing Address - Street 1:428 ROAD 1AF
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-8103
Mailing Address - Country:US
Mailing Address - Phone:307-645-3322
Mailing Address - Fax:307-645-3030
Practice Address - Street 1:428 ROAD 1AF
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-8103
Practice Address - Country:US
Practice Address - Phone:307-645-3322
Practice Address - Fax:307-645-3030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children