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General NPI Number Information
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NPI Number | 1124366406
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Entity Type | Organization
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Legal Business Name | RIDGEVIEW DRIVE RANCH, LLC
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Dates
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Enumeration Date | 01/22/2013
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 741 W WOODBURY RD
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City | ALTADENA
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State | CA
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Zip | 91001
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Country | US
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Telephone | 800-296-1868
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Fax |
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Provider Business Mailing Address
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Address Line | 3085 RIDGEVIEW DR
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City | ALTADENA
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State | CA
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Zip | 91001-4527
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Country | US
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Telephone | 800-296-1868
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Fax | 310-836-4500
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | LARRY THORNTON
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Credential |
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Telephone | 626-482-3478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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