Healthcare Provider Details

I. General information

NPI: 1649230236
Provider Name (Legal Business Name): THE BUCKEYE RANCH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4653 E MAIN ST
WHITEHALL OH
43213-3298
US

IV. Provider business mailing address

4653 E MAIN ST
WHITEHALL OH
43213-3298
US

V. Phone/Fax

Practice location:
  • Phone: 614-384-7798
  • Fax: 614-384-7703
Mailing address:
  • Phone: 614-384-7798
  • Fax: 614-384-7703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number1469, 1642
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number03153
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number1642
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number0153
License Number StateOH

VIII. Authorized Official

Name: LEIGH ANN TURNER
Title or Position: HR CREDENTIALING SPECIALIST
Credential:
Phone: 614-539-6639