Provider Demographics
NPI:1942758909
Name:TRUTH RECOVERY FOUNDATION
Entity type:Organization
Organization Name:TRUTH RECOVERY FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILEY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:THORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-703-9185
Mailing Address - Street 1:810 PALM ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95110-3030
Mailing Address - Country:US
Mailing Address - Phone:408-500-6229
Mailing Address - Fax:
Practice Address - Street 1:810 PALM ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110-3030
Practice Address - Country:US
Practice Address - Phone:408-500-6229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA430080AN3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children