Healthcare Provider Details

I. General information

NPI: 1942335914
Provider Name (Legal Business Name): CHILDREN'S RECOVERY CENTER, I LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3777 S. BASCOM AVE
CAMPBELL CA
95008
US

IV. Provider business mailing address

3777 S. BASCOM AVENUE
CAMPBELL CA
95008
US

V. Phone/Fax

Practice location:
  • Phone: 408-558-3640
  • Fax: 408-377-1139
Mailing address:
  • Phone: 408-358-3640
  • Fax: 408-377-1139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number070000320
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code283XC2000X
TaxonomyChildren's Rehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH SHAWN MCGUIRE
Title or Position: PRESIDENT/CEO
Credential:
Phone: 408-340-1568