Provider Demographics
NPI:1588279152
Name:SEEDS WILDERNESS THERAPY
Entity type:Organization
Organization Name:SEEDS WILDERNESS THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:719-426-7643
Mailing Address - Street 1:1771 N TOWNSEND AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5932
Mailing Address - Country:US
Mailing Address - Phone:719-970-5965
Mailing Address - Fax:
Practice Address - Street 1:1771 N TOWNSEND AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5932
Practice Address - Country:US
Practice Address - Phone:970-765-8919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility