Provider Demographics
NPI:1679378137
Name:NORTHRIDGE RANCH
Entity type:Organization
Organization Name:NORTHRIDGE RANCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHANCE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-675-0999
Mailing Address - Street 1:5954 BROADWAY BLVD # 105
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-5822
Mailing Address - Country:US
Mailing Address - Phone:972-806-0877
Mailing Address - Fax:
Practice Address - Street 1:6 NORTHRIDGE LN
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-8323
Practice Address - Country:US
Practice Address - Phone:972-806-0877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-18
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No174200000XOther Service ProvidersMeals
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No177F00000XOther Service ProvidersLodging
No251B00000XAgenciesCase Management
No273Y00000XHospital UnitsRehabilitation Unit
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility