Provider Demographics
NPI:1457873317
Name:BH-SD SOCIAL REHAB LM, LLC
Entity Type:Organization
Organization Name:BH-SD SOCIAL REHAB LM, LLC
Other - Org Name:JACKSON HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGBRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:ESQUIRE
Authorized Official - Phone:619-667-6009
Mailing Address - Street 1:7050 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-1535
Mailing Address - Country:US
Mailing Address - Phone:619-667-6009
Mailing Address - Fax:
Practice Address - Street 1:5332 JACKSON DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3040
Practice Address - Country:US
Practice Address - Phone:619-667-6009
Practice Address - Fax:619-667-6118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-12
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
320800000X
CA374603946323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility