Provider Demographics
NPI:1154536688
Name:ASC RIVERSIDE RANCH - RIVER HOUSE
Entity type:Organization
Organization Name:ASC RIVERSIDE RANCH - RIVER HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:661-871-9697
Mailing Address - Street 1:18200 HIGHWAY 178
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-9510
Mailing Address - Country:US
Mailing Address - Phone:661-871-9697
Mailing Address - Fax:661-871-1270
Practice Address - Street 1:18200 HIGHWAY 178
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-9510
Practice Address - Country:US
Practice Address - Phone:661-871-9697
Practice Address - Fax:661-871-1270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA157200413320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness