BH-SD Social Rehab LM, LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

BH-SD SOCIAL REHAB LM, LLC

Doing business as

Jackson House

Practice address

5332 Jackson Dr
La Mesa, CA 91942-3040

Phone

(619) 667-6009

Fax

(619) 667-6118

NPI assigned

Jul 12, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Chad Engbrecht, ESQUIRE

Title

Chief Financial Officer

Phone

(619) 667-6009

Specialties & licenses 2

Addresses

Other names 1

• Jackson House Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1499817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704931200000",
    "number": "1457873317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7050 PARKWAY DR",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919421535",
            "telephone_number": "619-667-6009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5332 JACKSON DR",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919423040",
            "telephone_number": "619-667-6009",
            "fax_number": "619-667-6118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BH-SD SOCIAL REHAB LM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-12",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A",
        "authorized_official_last_name": "ENGBRECHT",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "619-667-6009",
        "authorized_official_credential": "ESQUIRE"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "CA",
            "license": "374603946",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mental Illness Community Based Residential Treatment Facility in La Mesa, CA
• Providers in La Mesa, CA by specialty
• Mental Illness Community Based Residential Treatment Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.