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General NPI Number Information
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NPI Number | 1952038929
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Entity Type | Organization
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Legal Business Name | RANCHO SAN ANTONIO BOYS HOME, INC.
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Dates
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Enumeration Date | 08/01/2022
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 21044 PLUMMER ST
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City | CHATSWORTH
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State | CA
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Zip | 91311-4903
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Country | US
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Telephone | 818-882-6400
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Fax | 818-882-6404
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Provider Business Mailing Address
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Address Line | 21000 PLUMMER ST
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City | CHATSWORTH
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State | CA
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Zip | 91311-4903
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Country | US
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Telephone | 818-882-6400
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH DIRECTOR
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Name | KELLEY BUTLER
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Credential | LCSW
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Telephone | 818-882-6400
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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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