Provider Demographics
NPI:1538472030
Name:RANCHO L'ABRI HEALTH GROUP, LLC
Entity Type:Organization
Organization Name:RANCHO L'ABRI HEALTH GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:NEWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-210-0598
Mailing Address - Street 1:4660 LA JOLLA VILLAGE DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-4601
Mailing Address - Country:US
Mailing Address - Phone:858-210-0598
Mailing Address - Fax:858-210-0598
Practice Address - Street 1:3777 4TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4202
Practice Address - Country:US
Practice Address - Phone:619-704-3737
Practice Address - Fax:619-468-9390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder