Provider Demographics
NPI:1316508559
Name:FRONT RANGE RANCH & RESCUE
Entity type:Organization
Organization Name:FRONT RANGE RANCH & RESCUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MYHRE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, NLC
Authorized Official - Phone:970-449-2231
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OR
Mailing Address - Zip Code:97865-0095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27808 WIDOWS CREEK RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OR
Practice Address - Zip Code:97865-6152
Practice Address - Country:US
Practice Address - Phone:970-889-2752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1427526433Medicaid