| St. Jude's Ranch For Children | |
|
100 Saint Judes St Boulder City NV 89005-1614 | |
| (702) 294-7100 | |
| (702) 294-7171 |
| Full Name | St. Jude's Ranch For Children |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 100 Saint Judes St, Boulder City, Nevada |
| Authorized Official Name and Position | Hannah L Ware (CLINICAL DIRECTOR) |
| Authorized Official Contact | 7022947135 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Jude's Ranch For Children Po Box 60100 Boulder City NV 89006-0100 Ph: (702) 294-7100 | St. Jude's Ranch For Children 100 Saint Judes St Boulder City NV 89005-1614 Ph: (702) 294-7100 |
| NPI Number | 1790089209 |
|---|---|
| Provider Enumeration Date | 12/28/2010 |
| Last Update Date | 08/01/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790089209 | NPI | - | NPPES |
| 9005043433 | Medicaid | NV | |
| 9005043441 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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