Healthcare Provider Details

I. General information

NPI: 1437093473
Provider Name (Legal Business Name): EAST BAY MENS RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 W 6TH ST
ANTIOCH CA
94509-1602
US

IV. Provider business mailing address

415 W 6TH ST
ANTIOCH CA
94509-1602
US

V. Phone/Fax

Practice location:
  • Phone: 800-418-6139
  • Fax:
Mailing address:
  • Phone: 800-418-6139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY AIELLO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 925-628-1847