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General NPI Number Information
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NPI Number | 1639526288
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Entity Type | Organization
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Legal Business Name | R HOUSE INC
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Dates
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Enumeration Date | 05/24/2016
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Last Update Date | 05/24/2016
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Provider Practice Location Address
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Address Line | 540 MIDDLE RINCON RD
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City | SANTA ROSA
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State | CA
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Zip | 95409-3107
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Country | US
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Telephone | 707-322-1903
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2587
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City | SANTA ROSA
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State | CA
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Zip | 95405-0587
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | REESE CLARK
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Credential |
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Telephone | 707-322-1903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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