Healthcare Provider Details

I. General information

NPI: 1760516702
Provider Name (Legal Business Name): R HOUSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 SPEERS ROAD
SANTA ROSA CA
95409
US

IV. Provider business mailing address

PO BOX 2587
SANTA ROSA CA
95405
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 Number490105716
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number490011AN
License Number StateCA

VIII. Authorized Official

Name: SABRINA COYLE-JOHNSON
Title or Position: EXECUTIVE DIRECTOR
Credential: LMFT, RAS
Phone: 707-571-2215