Provider Demographics
NPI:1518150069
Name:CRUTCHER'S SERENITY HOUSE, INC.
Entity Type:Organization
Organization Name:CRUTCHER'S SERENITY HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-682-1368
Mailing Address - Street 1:PO BOX 1297
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95759-1297
Mailing Address - Country:US
Mailing Address - Phone:916-682-1368
Mailing Address - Fax:916-682-4533
Practice Address - Street 1:50 HILLCREST RD
Practice Address - Street 2:
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-9755
Practice Address - Country:US
Practice Address - Phone:707-963-3192
Practice Address - Fax:707-963-2309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-18
Last Update Date:2007-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA280001AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility