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General NPI Number Information
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NPI Number | 1023566445
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Entity Type | Organization
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Legal Business Name | HEALING WATERS RECOVERY, LLC EASTVALE
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Dates
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Enumeration Date | 09/14/2016
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | 13757 ASPEN LEAF LANE
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City | EASTVALE
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State | CA
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Zip | 92880
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Country | US
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Telephone | 772-233-0677
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Fax |
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Provider Business Mailing Address
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Address Line | 19069 VAN BUREN BLVD 114 116
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City | RIVERSIDE
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State | CA
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Zip | 92508
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Country | US
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Telephone | 772-233-0677
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. DARLENE MARIE LEON
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Credential |
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Telephone | 772-233-0677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 201617610555
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License Number State | CA
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