Basic Information
| Provider Information | |||||||||
| NPI: | 1649230236 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE BUCKEYE RANCH, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4653 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WHITEHALL | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432133298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143847798 | ||||||||
| FaxNumber: | 6143847703 | ||||||||
| Practice Location | |||||||||
| Address1: | 4653 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WHITEHALL | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432133298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143847798 | ||||||||
| FaxNumber: | 6143847703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2006 | ||||||||
| LastUpdateDate: | 10/25/2022 | ||||||||
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| AuthorizedOfficialLastName: | TURNER | ||||||||
| AuthorizedOfficialFirstName: | LEIGH | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | HR CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 6145396639 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 323P00000X | 1469, 1642 | OH | N | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | 3245S0500X | 03153 | OH | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children | 385HR2055X | 1642 | OH | N | Respite Care Facility | Respite Care | Respite Care, Mental Illness, Child | 261QM0855X | 0153 | OH | Y | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 2864235 | 01 | OH | OHIO MITS PROVIDER | OTHER | 3153 | 01 | OH | MACSIS UPI | OTHER |