Provider Demographics
NPI:1679282370
Name:ALL GROWN UP IRON GATE CAMPUS
Entity type:Organization
Organization Name:ALL GROWN UP IRON GATE CAMPUS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KADE
Authorized Official - Middle Name:
Authorized Official - Last Name:JANES
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:480-338-2176
Mailing Address - Street 1:100 N 200 W
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-2536
Mailing Address - Country:US
Mailing Address - Phone:435-868-8391
Mailing Address - Fax:
Practice Address - Street 1:100 N 200 W
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-2536
Practice Address - Country:US
Practice Address - Phone:435-868-8391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-21
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility