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NPI Code Detail

MEDICARE: ARCHWAY RECOVERY SERVICES INC

MEDICARE: ARCHWAY RECOVERY SERVICES 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
1324500000XSubstance Abuse Rehabilitation Facility480022APCA

General Provider Information

NPI Number : 1407915473
Entity Type Code : Organization
Provider Name (Legal Business Name) : ARCHWAY RECOVERY SERVICES INC
Provider Business Mailing Address
First Line : 609 JEFFERSON ST
Second Line :
City : FAIRFIELD
State : CA
Zip : 94533-6293
Country : US
Telephone Number : 707-399-9190
Fax Number : 707-948-0150
Provider Business Practice Location Address
First Line : 1525 UNION AVE
Second Line :
City : FAIRFIELD
State : CA
Zip : 94533-5049
Country : US
Telephone Number : 707-435-1804
Fax Number : 707-435-9807
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. KEVIN PHILLIPS
Credential :
Telephone Number : 707-399-9190
Provider Enumeration Date : 12/06/2006
Last Update Date : 03/03/2023

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