Provider Demographics
NPI:1093606519
Name:RANCHERO CLINIC, LLC
Entity type:Organization
Organization Name:RANCHERO CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:RANCHERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:447-219-1163
Mailing Address - Street 1:825 18TH ST STE 238
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-2940
Mailing Address - Country:US
Mailing Address - Phone:447-219-1163
Mailing Address - Fax:408-715-5734
Practice Address - Street 1:825 18TH ST STE 238
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-2940
Practice Address - Country:US
Practice Address - Phone:447-219-1594
Practice Address - Fax:408-715-5734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-12
Last Update Date:2025-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health