Basic Information
| Provider Information | |||||||||
| NPI: | 1679103006 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RITE OF PASSAGE ADOLESCENT TREATMENT CENTERS AND SCHOOLS, INC. | ||||||||
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| OtherOrganizationName: | ROP HARBOR CITY HOME | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2560 BUSINESS PKWY STE B | ||||||||
| Address2: | |||||||||
| City: | MINDEN | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894238961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7753922657 | ||||||||
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| Practice Location | |||||||||
| Address1: | 537 W 8TH ST | ||||||||
| Address2: | |||||||||
| City: | SAN PEDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907313119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108341198 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2020 | ||||||||
| LastUpdateDate: | 08/04/2021 | ||||||||
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| AuthorizedOfficialLastName: | ALEXANDER | ||||||||
| AuthorizedOfficialFirstName: | RUSTY | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS MANAGING DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7753922639 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | RITE OF PASSAGE ADOLESCENT TREATMENT CENTERS AND SCHOOLS INC. | ||||||||
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| NPICertificationDate: | 08/04/2021 | ||||||||
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.