Provider Demographics
NPI:1972651651
Name:THE SHEPHERD'S RANCH, INC.
Entity Type:Organization
Organization Name:THE SHEPHERD'S RANCH, INC.
Other - Org Name:HIDDEN MEADOWS CHRISTIAN YOUTH RANCH, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:EAP II, CHA II, CSSI
Authorized Official - Phone:336-492-2308
Mailing Address - Street 1:209 HIDDEN MEADOWS TRL
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-4976
Mailing Address - Country:US
Mailing Address - Phone:336-492-2308
Mailing Address - Fax:336-492-2308
Practice Address - Street 1:209 HIDDEN MEADOWS TRL
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-4976
Practice Address - Country:US
Practice Address - Phone:336-492-2308
Practice Address - Fax:336-492-2308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300982Medicaid