Healthcare Provider Details

I. General information

NPI: 1982250601
Provider Name (Legal Business Name): ROCKING HORSE RANCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10310 CIRCA VALLE VERDE
EL CAJON CA
92021-2219
US

IV. Provider business mailing address

10310 CIRCA VALLE VERDE
EL CAJON CA
92021-2219
US

V. Phone/Fax

Practice location:
  • Phone: 619-884-1351
  • Fax:
Mailing address:
  • Phone: 619-884-1351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN MICHELLE SAN FILIPPO
Title or Position: EXECUTIVE DIRECTOR
Credential: TRAUMA SPECIALIST
Phone: 619-884-1351