Provider Demographics
NPI:1205472198
Name:ROBINSON HOUSE
Entity type:Organization
Organization Name:ROBINSON HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAYWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-545-4462
Mailing Address - Street 1:1476 W 9TH ST STE B1
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5699
Mailing Address - Country:US
Mailing Address - Phone:951-545-4462
Mailing Address - Fax:909-981-6528
Practice Address - Street 1:904 W 9TH ST
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4576
Practice Address - Country:US
Practice Address - Phone:951-545-4462
Practice Address - Fax:909-577-0111
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JANET'S ENTERPRISE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA240000122Medicaid
CA24000122Medicaid