Healthcare Provider Details

I. General information

NPI: 1942366158
Provider Name (Legal Business Name): LA CHEIM RESIDENTIAL TREATMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5860 MCBRYDE AVE
RICHMOND CA
94805-1162
US

IV. Provider business mailing address

5860 MCBRYDE AVE
RICHMOND CA
94805-1162
US

V. Phone/Fax

Practice location:
  • Phone: 510-236-0444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT C. GARRIOTT
Title or Position: PROGRAM DIRECTOR
Credential: PH.D.
Phone: 510-236-0444