Novo Ranch LLC

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

20426 Issued in UT

Legal business name

NOVO RANCH LLC

Practice address

3549 W 1000 North
Roosevelt, UT 84066

Phone

(435) 823-4472

NPI assigned

Mar 22, 2013

Last updated

Mar 22, 2013By 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

Beau D Hancock

Title

Operations Director

Phone

(435) 823-4472

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1363910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363910400000",
    "number": "1760724280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "RR 4 BOX 4407",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "840669805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3549 W 1000 NORTH",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "84066",
            "telephone_number": "435-823-4472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVO RANCH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-22",
        "last_updated": "2013-03-22",
        "status": "A",
        "authorized_official_last_name": "HANCOCK",
        "authorized_official_first_name": "BEAU",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OPERATIONS DIRECTOR",
        "authorized_official_telephone_number": "435-823-4472"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "UT",
            "license": "20426",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John D Nolte, MD
• Marci Dawn Norman
• Northeastern Utah Medical Group
• Northeastern Utah Medical Group
• Northeastern Utah Medical Group
• Christopher Timbrell Oborn, MS, LCMHC, CCT-P,NCC
• Douglas Collin Ogden, DDS
• Canela F Oldroyd
• Raeleen Orme, APRN
• Bryce S Pace

• Emotionally Disturbed Childrens' Residential Treatment Facility in Roosevelt, UT
• Providers in Roosevelt, UT by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2013; 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.