Provider Demographics
NPI:1487950002
Name:CHEMICAL DEPENDENCY & PAIN RECOVERY OF CA, LLC
Entity type:Organization
Organization Name:CHEMICAL DEPENDENCY & PAIN RECOVERY OF CA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-490-3460
Mailing Address - Street 1:4241 JUTLAND DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-3663
Mailing Address - Country:US
Mailing Address - Phone:858-490-3460
Mailing Address - Fax:858-490-3462
Practice Address - Street 1:4241 JUTLAND DR
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-3663
Practice Address - Country:US
Practice Address - Phone:858-490-3460
Practice Address - Fax:858-490-3462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA370123BP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility