Doctor Name: | THOMAS HATHORN |
NPI Number: | 1093118176 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 370139AN |
Business Practice Address: | 24352 Featherstone Canyon Rd. Lakeside, CA - 92040 |
Business Phone Number: | 6197977319 |
Business Fax Number: | |
Mailing Address: | Po Box 1279, LAKESIDE |
State: | CA |
Postal Code: | 920400908 |
Phone Number: | 8587174322 |
Fax Number: | |
NPI Enumeration Date: | 10/02/2014 |
NPI Last Update Date: | 10/02/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 324500000X |
License Number: | 370139AN |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Substance Abuse Rehabilitation Facility |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |