Estrella Vista Ranch LLC

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

BH-3062 Issued in AZ

Legal business name

ESTRELLA VISTA RANCH LLC

Practice address

4911 East Silk Wind Blvd
Dragoon, AZ 85609

Phone

(520) 586-9254

NPI assigned

Jun 10, 2008

Last updated

Jun 10, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Erica Tahse Palacios

Title

President

Phone

(602) 206-7687

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1213056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213056000000",
    "number": "1689834103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 235",
            "city": "DRAGOON",
            "state": "AZ",
            "postal_code": "856090235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4911 EAST SILK WIND BLVD",
            "city": "DRAGOON",
            "state": "AZ",
            "postal_code": "85609",
            "telephone_number": "520-586-9254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESTRELLA VISTA RANCH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-10",
        "last_updated": "2008-06-10",
        "status": "A",
        "authorized_official_last_name": "PALACIOS",
        "authorized_official_first_name": "ERICA",
        "authorized_official_middle_name": "TAHSE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "602-206-7687",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "AZ",
            "license": "BH-3062",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2008; 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.