Healthcare Provider Details

I. General information

NPI: 1245613678
Provider Name (Legal Business Name): RANCHO SAN ANTONIO BOYS HOME INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21000 PLUMMER ST
CHATSWORTH CA
91311-4903
US

IV. Provider business mailing address

21000 PLUMMER ST
CHATSWORTH CA
91311-4903
US

V. Phone/Fax

Practice location:
  • Phone: 818-882-6400
  • Fax: 818-882-6404
Mailing address:
  • Phone: 818-882-6400
  • Fax: 818-882-6404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ZEENAT K. BURSE
Title or Position: CONTRACTS AND COMPLIANCE DIRECTOR
Credential: LMFT
Phone: 818-882-6400