Provider Demographics
NPI:1285132423
Name:REIGNING GRACE RANCH
Entity type:Organization
Organization Name:REIGNING GRACE RANCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-466-2154
Mailing Address - Street 1:28150 N ALMA SCHOOL PKWY STE 103-481
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85262-8133
Mailing Address - Country:US
Mailing Address - Phone:480-466-2154
Mailing Address - Fax:
Practice Address - Street 1:28614 N 172ND STREET
Practice Address - Street 2:
Practice Address - City:RIO VERDE
Practice Address - State:AZ
Practice Address - Zip Code:85263
Practice Address - Country:US
Practice Address - Phone:480-466-2154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No174200000XOther Service ProvidersMeals
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No347C00000XTransportation ServicesPrivate Vehicle
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp