Healthcare Provider Details

I. General information

NPI: 1538472030
Provider Name (Legal Business Name): RANCHO L'ABRI HEALTH GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 06/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3777 4TH AVE
SAN DIEGO CA
92103-4202
US

IV. Provider business mailing address

4660 LA JOLLA VILLAGE DR SUITE 500
SAN DIEGO CA
92122-4601
US

V. Phone/Fax

Practice location:
  • Phone: 619-704-3737
  • Fax: 619-468-9390
Mailing address:
  • Phone: 858-210-0598
  • Fax: 858-210-0598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. DAVID G NEWSON
Title or Position: CEO
Credential:
Phone: 858-210-0598