Provider Demographics
NPI:1215528260
Name:ST. JUDE'S RANCH FOR CHILDREN
Entity type:Organization
Organization Name:ST. JUDE'S RANCH FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BELLEROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-381-2229
Mailing Address - Street 1:200 WILSON CIR
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005-4401
Mailing Address - Country:US
Mailing Address - Phone:702-294-7100
Mailing Address - Fax:
Practice Address - Street 1:200 WILSON CIR
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005-4401
Practice Address - Country:US
Practice Address - Phone:702-294-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty