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General NPI Number Information
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NPI Number | 1255669404
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Entity Type | Organization
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Legal Business Name | RYAN'S WAY
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Dates
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Enumeration Date | 11/30/2009
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Last Update Date | 11/30/2009
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Provider Practice Location Address
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Address Line | 3453 AVELEY PL
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City | SAN DIEGO
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State | CA
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Zip | 92111-4727
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Country | US
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Telephone | 858-541-2632
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Fax | 858-541-2663
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Provider Business Mailing Address
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Address Line | PO BOX 212678
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City | CHULA VISTA
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State | CA
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Zip | 91921-2678
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Country | US
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Telephone | 619-852-3811
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Fax | 619-216-0587
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Authorized Official
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Title or Position | CEO
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Name | JAMIE O'CONNOR FLOREZ
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Credential |
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Telephone | 619-852-3811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 090000644
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License Number State | CA
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