Provider Demographics
NPI:1497253561
Name:SBT HEALTH INC
Entity type:Organization
Organization Name:SBT HEALTH INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESI
Authorized Official - Prefix:
Authorized Official - First Name:ERICH
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTIGAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-813-2597
Mailing Address - Street 1:25819 JEFFERSON AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6965
Mailing Address - Country:US
Mailing Address - Phone:951-813-2597
Mailing Address - Fax:
Practice Address - Street 1:25819 JEFFERSON AVE STE 110-120
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-6964
Practice Address - Country:US
Practice Address - Phone:951-813-2597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SBT HEALTH, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-24
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health