San Diego Freedom Ranch, Inc.
Organization Active NPI Substance Abuse Rehabilitation Facility · Campo, CA
NPI 1093937591 · NPPES record last updated Aug 31, 2020
Key facts
- NPI
- 1093937591
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Substance Abuse Rehabilitation Facility 324500000X
- License
- 370004AN (CA)
- Legal business name
- SAN DIEGO FREEDOM RANCH, INC.
- Practice address
- 1777 Buckman Springs Rd
Campo, CA 91906 - Phone
- (619) 478-5696
- Fax
- (619) 478-2404
- NPI assigned
- May 3, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Michael Lee Huffaker, CADC II, ICADC
- Title
- Operations Manager
- Phone
- (619) 478-5696
Practitioners 83
-
Kyle Andrew Jordan, CADC II, ICADC, AS
-
Andrea Acuna Eyraud, RADT
-
Zachary Baker, RADT
-
Brian M Baldwin, SUDRC
-
Caitlyn N Baldwin, RADT
-
Zachariah Ryan Barrett, CMPSS
-
Matteson Brickner, RADT
-
Joshua Steven Bruce, CPSS
-
Bryan S Burke, RADT
-
Corinna D. Bynum, RN
-
Nereyda Cabrera, RADT
-
Chantal Camarena, RADT
-
Ann Carter, RN
-
Corey Adam Cartwright, RADT
-
Natalie Chavez, RADT
-
Roy Colbourne, RADT
-
Lucas Anthony Cook, RADT
-
Carmen Correa, RADT
-
Justin Davis, RADT
-
John Francis De Hamm, CADC-CAS
-
Michael George Dehamm, CADC II, ICADC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D2324530 | San Diego Freedom Ranch, Inc | Certificate of waiver | May 26, 2027 |
National Provider Directory
Locations
1777 Buckman Springs Rd
Campo, CA 91906
Phone (619) 478-5696
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Substance Abuse Rehabilitation Facility | 324500000X | 370004AN | CA | Yes |
Addresses
Primary practice location
1777 Buckman Springs Rd
Campo, CA 91906
Mailing address
PO Box 157
Campo, CA 91906
Phone (619) 478-5696
Other providers in Campo, CA
- Giselle Ramirez
- Ronald Reza
- Patrick Ethan Ridge
- Matthew W Rogers
- Luzviminda Dulnuan Saidro
- Jonathan Sandoval
- Christopher David Serna
- Richard Adali Shaplin
- Tim Shaplin
- Colin Sheehan
All providers in Campo, CA · Substance Abuse Rehabilitation Facility in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 31, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.