Basic Information
Provider Information
NPI: 1285889873
EntityType: 2
ReplacementNPI:  
OrganizationName: FALCON RIDGE RANCH INC
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Mailing Information
Address1: 747 E SAINT GEORGE BLVD
Address2:  
City: ST GEORGE
State: UT
PostalCode: 847703035
CountryCode: US
TelephoneNumber: 4356736111
FaxNumber: 4356730994
Practice Location
Address1: 633 E HWY 9
Address2:  
City: VIRGIN
State: UT
PostalCode: 84779
CountryCode: US
TelephoneNumber: 4356736111
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/24/2008
LastUpdateDate: 06/24/2015
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AuthorizedOfficialLastName: PACE
AuthorizedOfficialFirstName: BRIAN
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AuthorizedOfficialTitleorPosition: EXECUTIVE DIRECTOR
AuthorizedOfficialTelephone: 4356736111
IsSoleProprietor:  
IsOrganizationSubpart: N
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
324500000X13368UTN Residential Treatment FacilitiesSubstance Abuse Rehabilitation Facility 
323P00000X13368UTY Residential Treatment FacilitiesPsychiatric Residential Treatment Facility 

No ID Information.


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