White Pine Boys Ranch, LLC

NPI #1437595568 in Ely, Nevada

Provider Information

NPI Number: 1437595568
Entity Type: Organization
Organization Name: White Pine Boys Ranch, LLC
Primary Specialty: Residential Treatment Facility, Emotionally Disturbed Children
Enumeration Date: May 15, 2013
Last Updated: May 15, 2013

Practice Location

Address: HC 34 BOX 34165
City: Ely
State: Nevada
ZIP Code: 89301-9206
Phone: (775) 238-5100

Authorized Official

Name: MR. LAWRENCE ALAN BRADLEY, M.A., LMFT
Title: EXECUTIVE DIRECTOR
Phone: (775) 238-5100

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Substance Abuse Rehabilitation Facility - Substance Abuse Treatment, Children — Substance Abuse Treatment, Children	3245S0500X
Residential Treatment Facility, Emotionally Disturbed Children	322D00000X	Primary

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