# ESTRELLA VISTA RANCH LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689834103
- **Authorized official:** MRS. ERICA TAHSE PALACIOS (PRESIDENT)
- **Authorized official phone:** (602) 206-7687

## Contact information

- **Practice address:** 4911 EAST SILK WIND BLVD, DRAGOON, AZ 85609
- **Practice address phone:** (520) 586-9254
- **Mailing address:** PO BOX 235, DRAGOON, AZ 85609-0235

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | BH-3062 | AZ | Yes |

## Other

- **Enumeration date:** 06/10/2008
- **Last updated:** 06/10/2008