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General NPI Number Information
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NPI Number | 1679378137
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Entity Type | Organization
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Legal Business Name | NORTHRIDGE RANCH
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Dates
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Enumeration Date | 02/18/2025
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 6 NORTHRIDGE LN
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City | ROCKWALL
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State | TX
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Zip | 75087-8323
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Country | US
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Telephone | 972-806-0877
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Fax |
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Provider Business Mailing Address
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Address Line | 5954 BROADWAY BLVD # 105
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City | GARLAND
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State | TX
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Zip | 75043-5822
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Country | US
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Telephone | 972-806-0877
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. CHANCE WILLIAM LUNA
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Credential |
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Telephone | 214-675-0999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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