Provider Demographics
NPI:1699949354
Name:DIAMOND RANCH ACADEMY
Entity type:Organization
Organization Name:DIAMOND RANCH ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEFFINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUNDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-598-7727
Mailing Address - Street 1:1500 E 2700 S
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-4000
Mailing Address - Country:US
Mailing Address - Phone:435-635-4297
Mailing Address - Fax:435-635-4436
Practice Address - Street 1:1500 E 2700 S
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-4000
Practice Address - Country:US
Practice Address - Phone:435-635-4297
Practice Address - Fax:435-635-4436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT00003823245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children