Organization
BH/BC OPCO SP LLC JACKSONHOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VERONICA MARIE RIOS (MHT)
(805) 625-4898
Entity
Organization
Contact information
Practice address
811 W TELEGRAPH RD, SANTA PAULA, CA 93060-5400
(805) 206-9064
Mailing address
546 N MILL ST # A, SANTA PAULA, CA 93060-1339
(805) 625-4898
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1538761010
MEDICAL
CA
Enumeration date
03/10/2022
Last updated
06/08/2022
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