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General NPI Number Information
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NPI Number | 1437971074
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Entity Type | Organization
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Legal Business Name | RESET HOUSE LLC
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Dates
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Enumeration Date | 10/25/2024
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 218 MARQUETTE AVE
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City | VALLEJO
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State | CA
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Zip | 94589-3713
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Country | US
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Telephone | 415-629-8511
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Fax |
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Provider Business Mailing Address
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Address Line | 707 MARIN ST STE C
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City | VALLEJO
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State | CA
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Zip | 94590-6173
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Country | US
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Telephone | 707-649-4100
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Fax | 707-649-4101
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Authorized Official
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Title or Position | OWNER
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Name | KIMBERLY PHAM
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Credential |
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Telephone | 415-629-8511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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