Healthcare Provider Details

I. General information

NPI: 1407934672
Provider Name (Legal Business Name): RUBICON, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 RADY ST
RICHMOND VA
23222-4097
US

IV. Provider business mailing address

1300 MACTAVISH AVE
RICHMOND VA
23230-4616
US

V. Phone/Fax

Practice location:
  • Phone: 804-767-6600
  • Fax: 804-321-2997
Mailing address:
  • Phone: 804-359-3255
  • Fax: 804-359-5137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number16101033
License Number StateVA

VIII. Authorized Official

Name: MRS. BARBARA J THORNHILL
Title or Position: DEPUTY DIRECTOR
Credential:
Phone: 804-381-6307