Provider Demographics
NPI:1255669404
Name:RYAN'S WAY
Entity Type:Organization
Organization Name:RYAN'S WAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:O'CONNOR
Authorized Official - Last Name:FLOREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-852-3811
Mailing Address - Street 1:PO BOX 212678
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91921-2678
Mailing Address - Country:US
Mailing Address - Phone:619-852-3811
Mailing Address - Fax:619-216-0587
Practice Address - Street 1:3453 AVELEY PL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-4727
Practice Address - Country:US
Practice Address - Phone:858-541-2632
Practice Address - Fax:858-541-2663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA090000644315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities