Provider Demographics
NPI:1871188193
Name:LIONROCK BEHAVIORAL HEALTH, INC
Entity Type:Organization
Organization Name:LIONROCK BEHAVIORAL HEALTH, INC
Other - Org Name:LIONROCK RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/SECRETARY/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:IAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRABB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-994-4990
Mailing Address - Street 1:911 LAKEVILLE ST # 322
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-3329
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13894 S BANGERTER PKWY STE 200
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-5320
Practice Address - Country:US
Practice Address - Phone:760-994-4990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIONROCK BEHAVIORAL HEALTH, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-08
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health