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General NPI Number Information
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NPI Number | 1760213490
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Entity Type | Organization
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Legal Business Name | RUBY'S PLACE
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Dates
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Enumeration Date | 08/13/2024
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 20880 BAKER RD
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-5729
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Country | US
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Telephone | 916-878-9458
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Fax |
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Provider Business Mailing Address
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Address Line | 20880 BAKER RD
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-5729
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Country | US
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Telephone | 916-878-9458
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SOPHORA ACHESON
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Credential | LMFT
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Telephone | 510-581-5626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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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 | 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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