Provider Demographics
NPI:1245613678
Name:RANCHO SAN ANTONIO BOYS HOME INC.
Entity Type:Organization
Organization Name:RANCHO SAN ANTONIO BOYS HOME INC.
Other - Org Name:RSA BRO JOHNS HOUSE STRTP
Other - Org Type:Other Name
Authorized Official - Title/Position:RESIDENTIAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-882-6400
Mailing Address - Street 1:21000 PLUMMER ST
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-4903
Mailing Address - Country:US
Mailing Address - Phone:818-882-6400
Mailing Address - Fax:818-882-6404
Practice Address - Street 1:21000 PLUMMER ST
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-4903
Practice Address - Country:US
Practice Address - Phone:818-882-6400
Practice Address - Fax:818-882-6404
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RANCHO SAN ANTONIO BOYS HOME INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
320800000X
CA191202023322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA19B7OtherMEDI-CAL PROVIDER NUMBER
CA02172OtherLA COUNTY DEPARTMENT OF MENTAL HEALTH