Provider Demographics
NPI:1386300770
Name:SAN GABRIEL RECOVERY RANCH LLC
Entity type:Organization
Organization Name:SAN GABRIEL RECOVERY RANCH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING & COLLECTIONS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-840-9167
Mailing Address - Street 1:1443 COUNTY ROAD 103
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-3854
Mailing Address - Country:US
Mailing Address - Phone:512-840-9167
Mailing Address - Fax:512-430-1394
Practice Address - Street 1:1443 COUNTY ROAD 103
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-3854
Practice Address - Country:US
Practice Address - Phone:512-840-9167
Practice Address - Fax:512-430-1394
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN GABRIEL RECOVERY RANCH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-10
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Single Specialty
No273R00000XHospital UnitsPsychiatric Unit