Healthcare Provider Details

I. General information

NPI: 1508314253
Provider Name (Legal Business Name): THE RANCH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
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: 301-874-4702
Mailing address:
  • Phone: 301-874-4701
  • Fax: 301-874-4702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number100773
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

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