Provider Demographics
NPI:1407934672
Name:RUBICON, INC
Entity Type:Organization
Organization Name:RUBICON, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:THORNHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-381-6307
Mailing Address - Street 1:1300 MACTAVISH AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-4616
Mailing Address - Country:US
Mailing Address - Phone:804-359-3255
Mailing Address - Fax:804-359-5137
Practice Address - Street 1:2825 RADY ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222-4097
Practice Address - Country:US
Practice Address - Phone:804-767-6600
Practice Address - Fax:804-321-2997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA16101033324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA04944542Medicaid