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General NPI Number Information
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NPI Number | 1043465008
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Entity Type | Organization
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Legal Business Name | CRC HEALTH GROUP
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Dates
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Enumeration Date | 11/18/2008
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Last Update Date | 11/18/2008
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Provider Practice Location Address
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Address Line | 1161 THIRD AVENUE
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City | CHULA VISTA
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State | CA
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Zip | 91911
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Country | US
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Telephone | 619-498-8260
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Fax |
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Provider Business Mailing Address
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Address Line | 766 10TH ST
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City | IMPERIAL BEACH
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State | CA
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Zip | 91932-2216
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Country | US
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Telephone | 619-395-2197
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | MR. EDWARD ANTHONY PIZANO JR.
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Credential | B.A.
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Telephone | 619-395-2197
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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 |
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