Provider Demographics
NPI:1306651146
Name:THE RANCH - TEAMMATES FOR LIFE
Entity type:Organization
Organization Name:THE RANCH - TEAMMATES FOR LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-306-2830
Mailing Address - Street 1:2026 TAYLOR ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-4649
Mailing Address - Country:US
Mailing Address - Phone:612-306-2830
Mailing Address - Fax:
Practice Address - Street 1:310 US 71 N
Practice Address - Street 2:
Practice Address - City:SAUK CENTRE
Practice Address - State:MN
Practice Address - Zip Code:56378-1144
Practice Address - Country:US
Practice Address - Phone:320-429-8808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-10
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health