Organization
LAZY HORSE RANCH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANN SUPPLEE (OWNER)
(520) 826-2206
Entity
Organization
Contact information
Practice address
3651 E DOE RANCH RD, PEARCE, AZ 85625-6002
(520) 826-2206
Mailing address
3651 E DOE RANCH RD, PEARCE, AZ 85625-6002
(520) 826-2206
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
CSA06ADHS0188
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
075457
AHCCS
AZ
Enumeration date
02/28/2007
Last updated
06/26/2008
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