NPIMap

Organization Active NPI

St. Jude's Ranch for Children

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Boulder City, NV
National Provider Identifier
1043377708
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
C3701994 Issued in NV
Legal business name
ST. JUDE'S RANCH FOR CHILDREN
Practice address
100 Saint Judes St
Boulder City, NV 89005-1614
Phone
(702) 294-7101
Fax
(702) 294-7191
NPI assigned
Jan 2, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Roland Charles Gant Jr.
Title
Residential Coordinator
Phone
(702) 294-7101

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X C3701994 NV Primary

Addresses

Primary practice location

100 Saint Judes St
Boulder City, NV 89005-1614

Mailing address

PO Box 60100
Boulder City, NV 89006-0100
Phone (702) 294-7101

National Provider Directory

National Provider Directory
Tax ID family
St Jude's Ranch for Children3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 72

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 72

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1043377708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60100",
            "city": "BOULDER CITY",
            "state": "NV",
            "postal_code": "890060100",
            "telephone_number": "702-294-7101",
            "fax_number": "702-294-7191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 SAINT JUDES ST",
            "city": "BOULDER CITY",
            "state": "NV",
            "postal_code": "890051614",
            "telephone_number": "702-294-7101",
            "fax_number": "702-294-7191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JUDE'S RANCH FOR CHILDREN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GANT",
        "authorized_official_first_name": "ROLAND",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "RESIDENTIAL COORDINATOR",
        "authorized_official_telephone_number": "702-294-7101",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NV",
            "license": "C3701994",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder City, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.