Provider Demographics
NPI:1891946638
Name:THE RANCH AT DOVE TREE LLC
Entity type:Organization
Organization Name:THE RANCH AT DOVE TREE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF LEGAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-716-4924
Mailing Address - Street 1:1406 E COUNTY ROAD 5800
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79403-6700
Mailing Address - Country:US
Mailing Address - Phone:817-778-8503
Mailing Address - Fax:817-310-1086
Practice Address - Street 1:1406 QUINLAN ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79403
Practice Address - Country:US
Practice Address - Phone:888-977-9264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE RANCH AT DOVE TREE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-09
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH5106OtherBCBS PROVIDER NUMBER FOR ALL CLAIMS TO BE PROCESSED