Organization
STORM RIDGE RANCH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARYANN LARSEN (DIRECTOR)
(435) 527-3191
Entity
Organization
Contact information
Practice address
95 W 3000 N, MONROE, UT 84754-3270
(435) 527-3191
(435) 527-3076
Mailing address
95 W 3000 N, MONROE, UT 84754-3270
(435) 527-3191
(435) 527-3076
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
11501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
788007788059
—
UT
Enumeration date
10/24/2006
Last updated
08/22/2020
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