Organization
NOVO RANCH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BEAU D HANCOCK (OPERATIONS DIRECTOR)
(435) 823-4472
Entity
Organization
Contact information
Practice address
3549 W 1000 NORTH, ROOSEVELT, UT 84066
(435) 823-4472
Mailing address
RR 4 BOX 4407, ROOSEVELT, UT 84066-9805
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
20426
UT
Other
Enumeration date
03/22/2013
Last updated
03/22/2013
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