Healthcare Provider Details

I. General information

NPI: 1326815432
Provider Name (Legal Business Name): THE RANCH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7902 FINGERBOARD RD
FREDERICK MD
21704-7629
US

IV. Provider business mailing address

PO BOX 42
BUCKEYSTOWN MD
21717-0042
US

V. Phone/Fax

Practice location:
  • Phone: 301-874-4701
  • Fax: 888-965-0597
Mailing address:
  • Phone: 301-874-4701
  • Fax: 888-965-0597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. JASON MICHAEL BARTH
Title or Position: EXECUTIVE DIRECTOR
Credential: LCPC
Phone: 301-874-4701