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NPI Code Detail

MEDICARE: LIONROCK BEHAVIORAL HEALTH, INC.

MEDICARE: LIONROCK BEHAVIORAL HEALTH, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1114495280
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIONROCK BEHAVIORAL HEALTH, INC.
Provider Business Mailing Address
First Line : 911 LAKEVILLE ST # 322
Second Line :
City : PETALUMA
State : CA
Zip : 94952-3329
Country : US
Telephone Number : 760-994-4990
Fax Number :
Provider Business Practice Location Address
First Line : 5 W MENDENHALL ST STE 202
Second Line :
City : BOZEMAN
State : MT
Zip : 59715-3566
Country : US
Telephone Number : 760-994-4990
Fax Number :
Authorized Official
Title or Position : COO/ADMIN
Name : IAIN CRABB
Credential :
Telephone Number : 760-994-4990
Provider Enumeration Date : 11/07/2018
Last Update Date : 11/07/2018

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Directions to “LIONROCK BEHAVIORAL HEALTH, INC. ” Practice Location

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