Provider Demographics
NPI:1215473699
Name:RITE OF PASSAGE, INC
Entity type:Organization
Organization Name:RITE OF PASSAGE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-267-9411
Mailing Address - Street 1:862 S MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-3389
Mailing Address - Country:US
Mailing Address - Phone:775-392-2657
Mailing Address - Fax:775-392-2544
Practice Address - Street 1:862 S MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-3389
Practice Address - Country:US
Practice Address - Phone:775-392-2657
Practice Address - Fax:775-392-2544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children