Provider Demographics
NPI:1457245029
Name:RANCHERO CLINIC, LLC
Entity type:Organization
Organization Name:RANCHERO CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position: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:630-696-0714
Mailing Address - Street 1:1034 W POLK AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-1709
Mailing Address - Country:US
Mailing Address - Phone:630-696-0714
Mailing Address - Fax:
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:630-696-0714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
1568656445OtherNPI