Healthcare Provider Details

I. General information

NPI: 1316247455
Provider Name (Legal Business Name): RECOVERY RESOURCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2010
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 SOUTH DEMAREE SUITE A
VISALIA CA
93277
US

IV. Provider business mailing address

4040 SOUTH DEMAREE SUITE A
VISALIA CA
93277
US

V. Phone/Fax

Practice location:
  • Phone: 559-625-8176
  • Fax: 559-625-8179
Mailing address:
  • Phone: 559-625-8176
  • Fax: 559-625-8179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number540020AP
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number540020AP
License Number StateCA

VIII. Authorized Official

Name: MRS. JERRI ELLEN THOMPSON
Title or Position: CO-OWNER DIRECTOR
Credential: NCAC-I,CADC-II,ICADC
Phone: 559-625-8176