Basic Information
| Provider Information | |||||||||
| NPI: | 1386764512 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RALSTON BEHAVIORAL HEALTH CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1911 WILLIAMS DR | ||||||||
| Address2: | 210 - BH BILLING DEPT | ||||||||
| City: | OXNARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930362612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059815478 | ||||||||
| FaxNumber: | 8059815187 | ||||||||
| Practice Location | |||||||||
| Address1: | 5740 RALSTON ST | ||||||||
| Address2: | SUITE 100, 200, 201, 110 | ||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930036051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8052893100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2007 | ||||||||
| LastUpdateDate: | 05/13/2015 | ||||||||
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| AuthorizedOfficialLastName: | EGAN | ||||||||
| AuthorizedOfficialFirstName: | NARCIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8056775140 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 000005688 | 05 | CA | MEDICAID |