Basic Information
| Provider Information | |||||||||
| NPI: | 1669956223 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RITE OF PASSAGE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2560 BUSINESS PKWY STE A | ||||||||
| Address2: | |||||||||
| City: | MINDEN | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894238961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7753922657 | ||||||||
| FaxNumber: | 7753922455 | ||||||||
| Practice Location | |||||||||
| Address1: | 3304 E I 80 SERVICE RD | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820098781 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3078297355 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2018 | ||||||||
| LastUpdateDate: | 05/11/2021 | ||||||||
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| AuthorizedOfficialLastName: | ALEXANDER | ||||||||
| AuthorizedOfficialFirstName: | RUSTY | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS MANAGING DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7753922639 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | RITE OF PASSAGE, INC | ||||||||
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| NPICertificationDate: | 12/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0855X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
No ID Information.