Provider Demographics
NPI:1376869560
Name:THE RANCH @ LA PLATA, LLC
Entity Type:Organization
Organization Name:THE RANCH @ LA PLATA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:P
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC, LCDC
Authorized Official - Phone:806-292-0017
Mailing Address - Street 1:121 WEST FOURTH
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:TX
Mailing Address - Zip Code:79045-0000
Mailing Address - Country:US
Mailing Address - Phone:806-360-3784
Mailing Address - Fax:806-364-5097
Practice Address - Street 1:121 WEST FOURTH
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:TX
Practice Address - Zip Code:79045-0000
Practice Address - Country:US
Practice Address - Phone:806-360-3784
Practice Address - Fax:806-364-5097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3270-3171251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health