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General NPI Number Information
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NPI Number | 1023486594
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Entity Type | Organization
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Legal Business Name | RECOVERY CHANNEL
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Dates
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Enumeration Date | 09/14/2015
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Last Update Date | 09/14/2015
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Provider Practice Location Address
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Address Line | 10000 RIVERSIDE DR SUITE #4
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City | TOLUCA LAKE
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State | CA
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Zip | 91602-2537
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Country | US
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Telephone | 916-752-8983
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Fax |
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Provider Business Mailing Address
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Address Line | 10000 RIVERSIDE DRIVE SUITE #4
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City | TOLUCA LAKE
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State | CA
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Zip | 91690-0000
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Country | US
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Telephone | 916-752-8983
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DENNIS HENNING
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Credential |
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Telephone | 916-752-8983
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | CA
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