Healthcare Provider Details

I. General information

NPI: 1457873317
Provider Name (Legal Business Name): BH-SD SOCIAL REHAB LM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5332 JACKSON DR
LA MESA CA
91942-3040
US

IV. Provider business mailing address

7050 PARKWAY DR
LA MESA CA
91942-1535
US

V. Phone/Fax

Practice location:
  • Phone: 619-667-6009
  • Fax: 619-667-6118
Mailing address:
  • Phone: 619-667-6009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number374603946
License Number StateCA

VIII. Authorized Official

Name: CHAD ENGBRECHT
Title or Position: CHIEF FINANCIAL OFFICER
Credential: ESQUIRE
Phone: 619-667-6009