1306651146 NPI number — THE RANCH - TEAMMATES FOR LIFE

Table of content: (NPI 1306651146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306651146 NPI number — THE RANCH - TEAMMATES FOR LIFE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE RANCH - TEAMMATES FOR LIFE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306651146
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2026 TAYLOR ST NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55418-4649
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-306-2830
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 US 71 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAUK CENTRE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56378-1144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-429-8808
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/10/2025

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GALLAGHER
Authorized Official First Name:
DERICK
Authorized Official Middle Name:
Authorized Official Title or Position:
BOARD MEMBER
Authorized Official Telephone Number:
612-306-2830

Provider Taxonomy Codes

  • Taxonomy code: 177F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)