Provider Demographics
NPI:1861820029
Name:DAVID J. RIORDAN'S HOBIE HOUSE
Entity Type:Organization
Organization Name:DAVID J. RIORDAN'S HOBIE HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-357-5261
Mailing Address - Street 1:1299 YOSEMITE PKWY
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-5265
Mailing Address - Country:US
Mailing Address - Phone:209-722-6335
Mailing Address - Fax:209-722-6371
Practice Address - Street 1:1299 YOSEMITE PKWY
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-5265
Practice Address - Country:US
Practice Address - Phone:209-722-6335
Practice Address - Fax:209-722-6371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-28
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240001BN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA240001BNOtherCALIFORNIA STATE DEPARTMENT OF HEALTH CARE SERVICES