Provider Demographics
NPI:1811014590
Name:THE LORDS RANCH
Entity Type:Organization
Organization Name:THE LORDS RANCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-647-2541
Mailing Address - Street 1:1033 OLD BURR RD
Mailing Address - Street 2:
Mailing Address - City:WARM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72478-9077
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1033 OLD BURR RD
Practice Address - Street 2:
Practice Address - City:WARM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72478-9077
Practice Address - Country:US
Practice Address - Phone:870-647-2541
Practice Address - Fax:870-647-2145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty