Healthcare Provider Details

I. General information

NPI: 1124483540
Provider Name (Legal Business Name): RECOVERY SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2015
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 STANDIFORD AVE SUITE F
MODESTO CA
95350-1159
US

IV. Provider business mailing address

823 E ORANGEBURG AVE
MODESTO CA
95350-4619
US

V. Phone/Fax

Practice location:
  • Phone: 209-579-5628
  • Fax: 209-579-5637
Mailing address:
  • Phone: 209-527-9797
  • Fax: 209-579-5637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number500004AP
License Number StateCA

VIII. Authorized Official

Name: GENE RADINO
Title or Position: OWNER
Credential:
Phone: 209-527-9797