Provider Demographics
NPI:1730611146
Name:RITE OF PASSAGE, INC
Entity type:Organization
Organization Name:RITE OF PASSAGE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEADRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-358-4997
Mailing Address - Street 1:2560 BUSINESS PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-8985
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5924 US HIGHWAY 285
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:CO
Practice Address - Zip Code:80465-9101
Practice Address - Country:US
Practice Address - Phone:130-338-4997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness