Healthcare Provider Details

I. General information

NPI: 1144687302
Provider Name (Legal Business Name): RITTER CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2016
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 MILL ST DINING ROOM
SAN RAFAEL CA
94901-4021
US

IV. Provider business mailing address

PO BOX 3517
SAN RAFAEL CA
94912-3517
US

V. Phone/Fax

Practice location:
  • Phone: 415-457-9651
  • Fax:
Mailing address:
  • Phone: 415-457-8182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number110000522
License Number StateCA

VIII. Authorized Official

Name: MS. CIA BYRNES
Title or Position: EXECUTIVE DIRECTOR
Credential: FNP-C
Phone: 415-457-8182