Healthcare Provider Details

I. General information

NPI: 1366304123
Provider Name (Legal Business Name): RECOVERY WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 BASE LINE RD STE A
RANCHO CUCAMONGA CA
91701-5829
US

IV. Provider business mailing address

34428 YUCAIPA BLVD # E309
YUCAIPA CA
92399-2474
US

V. Phone/Fax

Practice location:
  • Phone: 909-496-4281
  • Fax: 909-360-1332
Mailing address:
  • Phone: 909-496-4281
  • Fax: 909-360-1332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JODIE JAMES SANDERS III
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 909-496-4281