Healthcare Provider Details

I. General information

NPI: 1154536688
Provider Name (Legal Business Name): ASC RIVERSIDE RANCH - RIVER HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18200 HIGHWAY 178
BAKERSFIELD CA
93306-9510
US

IV. Provider business mailing address

18200 HIGHWAY 178
BAKERSFIELD CA
93306-9510
US

V. Phone/Fax

Practice location:
  • Phone: 661-871-9697
  • Fax: 661-871-1270
Mailing address:
  • Phone: 661-871-9697
  • Fax: 661-871-1270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number157200413
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL ROSBERG
Title or Position: PROGRAM DIRECTOR
Credential: PH.D
Phone: 661-871-9697