Provider Demographics
NPI:1053146076
Name:BUDDYS RANCH LLC
Entity type:Organization
Organization Name:BUDDYS RANCH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-632-8219
Mailing Address - Street 1:PO BOX 802
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95992-0802
Mailing Address - Country:US
Mailing Address - Phone:530-632-8219
Mailing Address - Fax:916-500-0609
Practice Address - Street 1:1303 GRAY AVE
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3204
Practice Address - Country:US
Practice Address - Phone:530-632-8219
Practice Address - Fax:916-500-0609
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BUDDYS RANCH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health