Provider Demographics
NPI:1699559138
Name:MASTER'S RANCH CHRISTIAN ACADEMY
Entity type:Organization
Organization Name:MASTER'S RANCH CHRISTIAN ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:417-274-0469
Mailing Address - Street 1:PO BOX 709
Mailing Address - Street 2:
Mailing Address - City:MYRTLE
Mailing Address - State:MO
Mailing Address - Zip Code:65778-0709
Mailing Address - Country:US
Mailing Address - Phone:417-264-6040
Mailing Address - Fax:
Practice Address - Street 1:287 COUNTY ROAD 275
Practice Address - Street 2:
Practice Address - City:MYRTLE
Practice Address - State:MO
Practice Address - Zip Code:65778-8341
Practice Address - Country:US
Practice Address - Phone:417-264-6040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children