NPIMap

Organization Active NPI

St. Jude's Ranch for Children

  • Community/Behavioral Health Agency
  • Boulder City, NV
National Provider Identifier
1215528260
Registry record updated Feb 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
ST. JUDE'S RANCH FOR CHILDREN
Practice address
200 Wilson Cir
Boulder City, NV 89005-4401
Phone
(702) 294-7100
NPI assigned
Feb 2, 2021
Last updated
Feb 2, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2021

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

Authorized official

Name
Tina Marie BelleroseNPI 1528594009
Title
Office Manager
Phone
(603) 381-2229

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 225400000X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

200 Wilson Cir
Boulder City, NV 89005-4401

Mailing address

200 Wilson Cir
Boulder City, NV 89005-4401
Phone (702) 294-7100

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 80

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 80

NPI Registry JSON

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

{
    "created_epoch": "1612224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612224000000",
    "number": "1215528260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 WILSON CIR",
            "city": "BOULDER CITY",
            "state": "NV",
            "postal_code": "890054401",
            "telephone_number": "702-294-7100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 WILSON CIR",
            "city": "BOULDER CITY",
            "state": "NV",
            "postal_code": "890054401",
            "telephone_number": "702-294-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JUDE'S RANCH FOR CHILDREN",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-02",
        "last_updated": "2021-02-02",
        "certification_date": "2021-02-02",
        "status": "A",
        "authorized_official_last_name": "BELLEROSE",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "603-381-2229"
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "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 Feb 2, 2021; 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.