ST. JUDE'S RANCH FOR CHILDREN (NPI# 1043377708) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043377708 |
| Entity Type | Organization |
| Organization Name | ST. JUDE'S RANCH FOR CHILDREN |
| Practice Address |
100 Saint Judes St Boulder City NV 89005-1614 |
| Mailing Address |
Po Box 60100 Boulder City NV 89006-0100 |
| Practice Telephone | 7022947101 |
| Practice Fax Number | 7022947191 |
| Mailing Telephone | 7022947101 |
| Mailing Fax Number | 7022947191 |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. ROLAND CHARLES GANT JR. (RESIDENTIAL COORDINATOR) |
| Authorized Official Telephone | 7022947101 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | C3701994 | NV | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790089209 | St. Jude's Ranch for Children | Community/Behavioral Health | 100 Saint Judes St, Boulder City, NV 89005-1614 | 2010-12-28 |
| Street Address |
100 SAINT JUDES ST |
| City | BOULDER CITY |
| State | NV |
| Zip Code | 89005-1614 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396271573 | Keana Clemens | Rehabilitation Practitioner | 100 Saint Judes St, Boulder City, NV 89005-1614 | 2017-05-05 |
| 1891221172 | Anastasia Hessel | Rehabilitation Practitioner | 100 Saint Judes St, Boulder City, NV 89005-1614 | 2017-05-05 |
| 1013363480 | Lyn Hall | Rehabilitation Practitioner | 100 Saint Judes St, Boulder City, NV 89005-1614 | 2016-05-04 |
| 1790147635 | Clentine Wright | Rehabilitation Practitioner | 100 Saint Judes St, Boulder City, NV 89005-1614 | 2016-03-21 |
| 1043670847 | Irene Lovelace | Rehabilitation Practitioner | 100 Saint Judes St, Boulder City, NV 89005-1614 | 2016-03-07 |
| 1770943623 | Torii Hayes | Rehabilitation Practitioner | 100 Saint Judes St, Boulder City, NV 89005-1614 | 2016-03-03 |
| 1306217757 | Elsie Spell | Behavioral Analyst | 100 Saint Judes St, Boulder City, NV 89005-1614 | 2015-10-12 |
| 1295134260 | Derek Johnson | Behavioral Analyst | 100 Saint Judes St, Boulder City, NV 89005-1614 | 2014-08-15 |
| 1104225176 | Allisa Johnson | Behavioral Analyst | 100 Saint Judes St, Boulder City, NV 89005-1614 | 2014-08-15 |
| 1881093805 | Salvation Moore | Behavioral Analyst | 100 Saint Judes St, Boulder City, NV 89005-1614 | 2014-08-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336763119 | Hitesh R Amin | Pharmacist | Sav-on Pharmacy, 1008 Nevada Way, Boulder City, NV 89005 | 2020-06-08 |
| 1871013086 | Wesley King | Rehabilitation Practitioner | 200 Wilson Circle, Boulder, NV 89005 | 2017-06-20 |
| 1568998714 | Bailey Godfrey | Registered Nurse | 1401 Pueblo Drive, Boulder City, NV 89005 | 2017-05-10 |
| 1972970127 | Elizabeth Anne Jones | Counselor | 202 Rainier Court, Boulder City, NV 89005 | 2015-08-24 |
| 1871913855 | Joy Reynolds | Rehabilitation Practitioner | 100 St. Jude's Street, Boulder City, NV 89005 | 2014-04-17 |
| 1710222815 | Laura Lynn Rivera | Counselor | 200 Wilson Cir, Boulder City, NV 89005 | 2012-11-30 |
| 1467723528 | Sandra Lee Miller | Community Health Worker | 659 Ave. H, Boulder City, NV 89005 | 2012-01-21 |
| 1689959272 | Eliscia Wight | Pharmacist | 101 E. Lake Mead Pkwy, Henderson, NV 89005 | 2011-10-15 |
| 1285876706 | National Park Service | Ambulance | 601 Nevada Hwy, Boulder City, NV 89005 | 2009-03-30 |
| 1861614679 | Rickey L. Smith | Pharmacist | 1008 Nevada Highway, Boulder City, NV 89005 | 2007-05-02 |
| Find all providers in zip 89005 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891282786 | Avenues 2 Success | Residential Treatment Facility, Emotionally Disturbed Children | 9520 Chanticleer Ct, Las Vegas, NV 89129-7858 | 2018-04-17 |
| 1215305818 | Levada House LLC | Residential Treatment Facility, Emotionally Disturbed Children | 3905 Clear Acre Ln Apt 27, Reno, NV 89512-1283 | 2015-09-13 |
| 1639423064 | Sunny Day Home Health | Residential Treatment Facility, Emotionally Disturbed Children | 1712 Sagebrush Ranch Way, N Las Vegas, NV 89081-6718 | 2012-11-07 |
| 1093030017 | Unepected Changes | Residential Treatment Facility, Emotionally Disturbed Children | 428 Marion Dr, Las Vegas, NV 89110-3473 | 2010-04-01 |
| 1245567486 | Luvin' Kare Transitional Services | Residential Treatment Facility, Emotionally Disturbed Children | 217 Delighted Ave, North Las Vegas, NV 89031-1395 | 2009-11-09 |
| 1679703805 | Horizon Academy LLC | Residential Treatment Facility, Emotionally Disturbed Children | Hc 70 Box 531, Amargosa Valley, NV 89020-9600 | 2009-07-22 |
| 1174766612 | Carol Ellen Harrison | Residential Treatment Facility, Emotionally Disturbed Children | 1700 Buckthorn Ct, Minden, NV 89423-4127 | 2009-04-14 |
| 1700046372 | London Family and Children's Services Inc | Residential Treatment Facility, Emotionally Disturbed Children | 2026 Silverton Dr, Henderson, NV 89074-1550 | 2008-06-16 |
| 1588821938 | Focal Point Academy | Residential Treatment Facility, Emotionally Disturbed Children | 560 W Mesquite Blvd, Mesquite, NV 89027-5137 | 2008-05-21 |
| 1306024773 | Father Flanagans Boys' Town | Residential Treatment Facility, Emotionally Disturbed Children | 8090 Flanagan Dr, Las Vegas, NV 89131-0200 | 2008-02-07 |
| Find all providers with the same taxonomy | ||||
| City | BOULDER CITY |
| Zip Code | 89005 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.