Healthcare Provider Details

I. General information

NPI: 1205605540
Provider Name (Legal Business Name): THE RECOVERY VILLAGE CALIFORNIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43700 CACTUS VALLEY RD
HEMET CA
92544-9337
US

IV. Provider business mailing address

100 SE 3RD AVE STE 1800
FORT LAUDERDALE FL
33394-0011
US

V. Phone/Fax

Practice location:
  • Phone: 305-785-5520
  • Fax: 888-919-4431
Mailing address:
  • Phone: 57-855-5203
  • Fax: 888-919-4431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: BELINA SURUJON
Title or Position: CONTRACTING & LICENSING DIRECTOR
Credential:
Phone: 305-785-5520