Basic Information
| Provider Information | |||||||||
| NPI: | 1528543212 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RITE OF PASSAGE ADOLESCENT TREATMENT CENTERS AND SCHOOLS INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TUSTIN FAMILY CAMPUS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2560 BUSINESS PKWY STE B | ||||||||
| Address2: | |||||||||
| City: | MINDEN | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894238961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7753922657 | ||||||||
| FaxNumber: | 7753922455 | ||||||||
| Practice Location | |||||||||
| Address1: | 15405 LANSDOWNE RD STE C | ||||||||
| Address2: | |||||||||
| City: | TUSTIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927820201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142587710 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2018 | ||||||||
| LastUpdateDate: | 02/01/2019 | ||||||||
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| AuthorizedOfficialLastName: | ALEXANDER | ||||||||
| AuthorizedOfficialFirstName: | RUSTY | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING BUSINESS DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7753922639 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | RITE OF PASSAGE ADOLESCENT TREATMENT CENTERS AND SCHOOLS INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0855X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
No ID Information.