Provider Demographics
NPI:1952038929
Name:RANCHO SAN ANTONIO BOYS HOME, INC.
Entity Type:Organization
Organization Name:RANCHO SAN ANTONIO BOYS HOME, INC.
Other - Org Name:RSA ST ANTHONYS HOUSE STRTP
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AUBREE
Authorized Official - Middle Name:LYND
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-882-6400
Mailing Address - Street 1:21000 PLUMMER ST
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-4903
Mailing Address - Country:US
Mailing Address - Phone:818-882-6400
Mailing Address - Fax:
Practice Address - Street 1:21044 PLUMMER ST
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-4903
Practice Address - Country:US
Practice Address - Phone:818-882-6400
Practice Address - Fax:818-882-6404
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RANCHO SAN ANTONIO BOYS HOME, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA19KIOtherMEDI-CAL