Organization
WHITE PINE BOYS RANCH, LLC
Active
Other names
Home on the Range Youth Ranch
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAWRENCE ALAN BRADLEY M.A., LMFT (EXECUTIVE DIRECTOR)
(775) 238-5100
Entity
Organization
Contact information
Practice address
HC 34 BOX 34165, ELY, NV 89301-9206
(775) 238-5100
(775) 238-5103
Mailing address
HC 34 BOX 34165, ELY, NV 89301-9206
(775) 238-5100
(775) 238-5103
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
1389-13
NV
3245S0500X
Children's Substance Abuse Rehabilitation Facility
1389-13
NV
Other
Enumeration date
05/15/2013
Last updated
05/15/2013
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