Healthcare Provider Details

I. General information

NPI: 1790164143
Provider Name (Legal Business Name): CEDAR POINT RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2015
Last Update Date: 06/12/2020
Certification Date: 06/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 CAL CENTER DR STE 160165
SACRAMENTO CA
95826-3259
US

IV. Provider business mailing address

8950 CAL CENTER DR STE 160165
SACRAMENTO CA
95826-3259
US

V. Phone/Fax

Practice location:
  • Phone: 732-982-2674
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: PRITI KUMAR
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 732-210-0509