Provider Demographics
NPI:1821746645
Name:BH/BC OPCO SP LLC JACKSONHOUSE
Entity Type:Organization
Organization Name:BH/BC OPCO SP LLC JACKSONHOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MHT
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-625-4898
Mailing Address - Street 1:546 N MILL ST # A
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-1339
Mailing Address - Country:US
Mailing Address - Phone:805-625-4898
Mailing Address - Fax:
Practice Address - Street 1:811 W TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-5400
Practice Address - Country:US
Practice Address - Phone:805-206-9064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-10
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1538761010OtherMEDICAL