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Stacy Roudebush
Substance Abuse Rehabilitation Facility in Rohnert Park, California
NPI 1730559303

Stacy Roudebush is a Substance Abuse Rehabilitation Facility based in Rohnert Park, CA. Stacy Roudebush practices in Rohnert Park, CA. The NPI Number for Stacy Roudebush is 1730559303 and holds a License No. B6655711 (California).

The current practice location address for Stacy Roudebush is 308 Firethorn Dr, Rohnert Park, CA and can be reached out via phone at 619-723-0385.

Location: 308 Firethorn Dr, Rohnert Park, CA, 94928-1321
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1730559303
Provider Name
Stacy Roudebush
Credential
Provider Entity Type
Individual
Gender
Female
Address
308 Firethorn Dr, Rohnert Park, CA, 94928-1321
Phone Number
619-723-0385
Fax Number
Provider Enumeration Date
09/25/2015
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
B6655711 05 CA
institution
Provider Business Practice Location Address Details
Address
308 Firethorn Dr
City
Rohnert Park
State
California
Zip
94928-1321
Phone Number
619-723-0385
Fax Number
person
Provider Business Mailing Address Details
Address
308 Firethorn Dr
City
Rohnert Park
State
California
Zip
94928-1321
Phone Number
619-723-0385
Fax Number
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Substance Abuse Rehabilitation Facility
Speciality
-
Taxonomy
324500000X
License No.
B6655711 (California)
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.
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