Organization
KIVA ADVENTURE RANCH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LANA BAUER (INSURANCE MANAGER)
(435) 592-1718
Entity
Organization
Contact information
Practice address
652 N SHADY LN, TOQUERVILLE, UT 84774-7741
(435) 272-1492
Mailing address
PO BOX 39, TOQUERVILLE, UT 84774-0039
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/13/2023
Last updated
01/13/2023
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