MEDICARE: BROADVIEW RECOVERY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1356156517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROADVIEW RECOVERY INC

Provider Business Mailing Address
First Line	:	7400 EL CAJON BLVD STE 302
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91942-7417
Country	:	US
Telephone Number	:	619-805-5105
Fax Number	:

Provider Business Practice Location Address
First Line	:	2009 69TH ST
Second Line	:
City	:	LEMON GROVE
State	:	CA
Zip	:	91945-3409
Country	:	US
Telephone Number	:	619-805-5105
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SHIVA D'AMOND
Credential	:	CADC-II
Telephone Number	:	619-805-5105

Provider Enumeration Date	:	02/12/2025
Last Update Date	:	07/24/2025

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Directions to “BROADVIEW RECOVERY INC ” Practice Location

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