Healthcare Provider Details

I. General information

NPI: 1467993782
Provider Name (Legal Business Name): CALIFORNIA PALMS ADDICTION RECOVERY CAMPUS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 N CANFIELD NILES RD
AUSTINTOWN OH
44515-1110
US

IV. Provider business mailing address

1051 N CANFIELD NILES RD
AUSTINTOWN OH
44515-1110
US

V. Phone/Fax

Practice location:
  • Phone: 330-935-2663
  • Fax:
Mailing address:
  • Phone: 330-935-2663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: SEBASTIAN RUCCI
Title or Position: OWNER
Credential:
Phone: 330-720-0398