Healthcare Provider Details

I. General information

NPI: 1528277969
Provider Name (Legal Business Name): R HOUSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 MIDDLE RINCON RD
SANTA ROSA CA
95409-3409
US

IV. Provider business mailing address

PO BOX 2587
SANTA ROSA CA
95405-0587
US

V. Phone/Fax

Practice location:
  • Phone: 707-571-2215
  • Fax: 707-526-9672
Mailing address:
  • Phone: 707-571-2215
  • Fax: 707-526-9672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number496800338
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number490011EN
License Number StateCA

VIII. Authorized Official

Name: MIMI G DONOHUE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 707-571-2215