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NPI Code Detail

MEDICARE: R HOUSE INC

MEDICARE: R HOUSE 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
13245S0500XChildren's Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number : 1639526288
Entity Type Code : Organization
Provider Name (Legal Business Name) : R HOUSE INC
Provider Business Mailing Address
First Line : PO BOX 2587
Second Line :
City : SANTA ROSA
State : CA
Zip : 95405-0587
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 540 MIDDLE RINCON RD
Second Line :
City : SANTA ROSA
State : CA
Zip : 95409-3107
Country : US
Telephone Number : 707-322-1903
Fax Number :
Authorized Official
Title or Position : CLINICAL DIRECTOR
Name : REESE CLARK
Credential :
Telephone Number : 707-322-1903
Provider Enumeration Date : 05/24/2016
Last Update Date : 05/24/2016

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