Healthcare Provider Details

I. General information

NPI: 1407700644
Provider Name (Legal Business Name): CITY RANCH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7613 DOGWOOD RD
WINDSOR MILL MD
21244-1202
US

IV. Provider business mailing address

7613 DOGWOOD RD
WINDSOR MILL MD
21244-1202
US

V. Phone/Fax

Practice location:
  • Phone: 410-456-2195
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: BRANDT KINGSLEY
Title or Position: OWNER
Credential:
Phone: 717-881-7487