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General NPI Number Information
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NPI Number | 1386300770
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Entity Type | Organization
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Legal Business Name | SAN GABRIEL RECOVERY RANCH LLC
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Dates
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Enumeration Date | 11/10/2021
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Last Update Date | 11/11/2021
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Provider Practice Location Address
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Address Line | 1443 COUNTY ROAD 103
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City | GEORGETOWN
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State | TX
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Zip | 78626-3854
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Country | US
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Telephone | 512-840-9167
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Fax | 512-430-1394
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Provider Business Mailing Address
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Address Line | 1443 COUNTY ROAD 103
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City | GEORGETOWN
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State | TX
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Zip | 78626-3854
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Country | US
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Telephone | 512-840-9167
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Fax | 512-430-1394
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Authorized Official
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Title or Position | BILLING & COLLECTIONS SPECIALIST
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Name | VALERIE A ANDERSON
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Credential |
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Telephone | 512-840-9167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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