Provider Demographics
NPI:1699091710
Name:SPRING RIDGE ACADEMY
Entity type:Organization
Organization Name:SPRING RIDGE ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:COURTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-925-5965
Mailing Address - Street 1:13690 S. BURTON RD.
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86333
Mailing Address - Country:US
Mailing Address - Phone:928-632-4602
Mailing Address - Fax:928-632-7661
Practice Address - Street 1:13690 S. BURTON RD.
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86333
Practice Address - Country:US
Practice Address - Phone:928-632-4602
Practice Address - Fax:928-632-7661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH1721323P00000X
AZBH-1721101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment FacilityGroup - Single Specialty