Healthcare Provider Details

I. General information

NPI: 1306651146
Provider Name (Legal Business Name): THE RANCH - TEAMMATES FOR LIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 US 71 N
SAUK CENTRE MN
56378-1144
US

IV. Provider business mailing address

2026 TAYLOR ST NE
MINNEAPOLIS MN
55418-4649
US

V. Phone/Fax

Practice location:
  • Phone: 320-429-8808
  • Fax:
Mailing address:
  • Phone: 612-306-2830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DERICK GALLAGHER
Title or Position: BOARD MEMBER
Credential:
Phone: 612-306-2830