Healthcare Provider Details

I. General information

NPI: 1831053453
Provider Name (Legal Business Name): SAN DIEGO CENTER FOR RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5935 JOEL LN
LA MESA CA
91942-4101
US

IV. Provider business mailing address

2821 LANGE AVE
SAN DIEGO CA
92122-3109
US

V. Phone/Fax

Practice location:
  • Phone: 747-265-9704
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: JOY CROWNOVER
Title or Position: COO
Credential:
Phone: 747-265-9704