Organization
RANCHO SAN ANTONIO BOYS HOME, INC.
Active
Parent organization
RANCHO SAN ANTONIO BOYS HOME, INC.
Other names
RSA St Anthonys House STRTP, Rancho San Antonio
Organization subpart
Yes
Provider details
NPI number
Legal business name
RANCHO SAN ANTONIO BOYS HOME, INC.
Authorized official
KELLEY BUTLER LCSW (MENTAL HEALTH DIRECTOR)
(818) 882-6400
Entity
Organization
Contact information
Practice address
21044 PLUMMER ST, CHATSWORTH, CA 91311-4903
(818) 882-6400
(818) 882-6404
Mailing address
21000 PLUMMER ST, CHATSWORTH, CA 91311-4903
(818) 882-6400
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
—
19KI
MEDI-CAL
CA
Enumeration date
08/01/2022
Last updated
11/18/2024
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