Basic Information
| Provider Information | |||||||||
| NPI: | 1316174261 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE RANCH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 670532 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752670532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6155677282 | ||||||||
| FaxNumber: | 6158072931 | ||||||||
| Practice Location | |||||||||
| Address1: | 6107 PINEWOOD RD | ||||||||
| Address2: | |||||||||
| City: | NUNNELLY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371372523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545877771 | ||||||||
| FaxNumber: | 9542522177 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2009 | ||||||||
| LastUpdateDate: | 09/19/2016 | ||||||||
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| AuthorizedOfficialLastName: | MAPLESDEN | ||||||||
| AuthorizedOfficialFirstName: | CHERYL | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 6155103078 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | CPC, CHC, CHPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 323P00000X | L000000017855 | TN | N | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | 324500000X | L000000003995 | TN | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.