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General NPI Number Information
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NPI Number | 1518150069
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Entity Type | Organization
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Legal Business Name | CRUTCHER'S SERENITY HOUSE, INC.
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Dates
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Enumeration Date | 08/18/2007
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Last Update Date | 08/18/2007
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Provider Practice Location Address
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Address Line | 50 HILLCREST RD
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City | SAINT HELENA
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State | CA
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Zip | 94574-9755
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Country | US
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Telephone | 707-963-3192
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Fax | 707-963-2309
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Provider Business Mailing Address
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Address Line | PO BOX 1297
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City | ELK GROVE
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State | CA
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Zip | 95759-1297
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Country | US
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Telephone | 916-682-1368
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Fax | 916-682-4533
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. MINDY LUBY
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Credential |
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Telephone | 916-682-1368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 280001AP
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License Number State | CA
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