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General NPI Number Information
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NPI Number | 1023826708
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Entity Type | Organization
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Legal Business Name | CALIFORNIA RECOVERY CENTER, LLC
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Dates
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Enumeration Date | 12/26/2024
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Last Update Date | 12/26/2024
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Provider Practice Location Address
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Address Line | 8026 COOK RIOLO RD
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City | ROSEVILLE
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State | CA
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Zip | 95747-9214
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Country | US
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Telephone | 916-400-9289
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Fax |
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Provider Business Mailing Address
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Address Line | 920 RESERVE DR STE 180
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City | ROSEVILLE
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State | CA
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Zip | 95678-1382
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | WILLIAM MENTESH
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Credential |
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Telephone | 916-622-4017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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