Healthcare Provider Details

I. General information

NPI: 1841669231
Provider Name (Legal Business Name): LYRIC RECOVERY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2015
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 S BASCOM AVE STE 205
SAN JOSE CA
95128-3535
US

IV. Provider business mailing address

1210 S BASCOM AVE STE 205
SAN JOSE CA
95128-3535
US

V. Phone/Fax

Practice location:
  • Phone: 408-216-9826
  • Fax:
Mailing address:
  • Phone: 408-216-9826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS M HAMES
Title or Position: CEO
Credential:
Phone: 408-216-9826