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General NPI Number Information
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NPI Number | 1164980603
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Entity Type | Organization
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Legal Business Name | SAN FERNANDO RECOVERY CENTER
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Dates
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Enumeration Date | 03/04/2019
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 762 GRISWOLD AVE
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City | SAN FERNANDO
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State | CA
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Zip | 91340-2105
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Country | US
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Telephone | 818-809-8868
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Fax |
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Provider Business Mailing Address
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Address Line | 762 GRISWOLD AVE
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City | SAN FERNANDO
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State | CA
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Zip | 91340-2105
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Country | US
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Telephone | 818-919-4210
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JOSE MARTINEZ
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Credential |
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Telephone | 818-809-8868
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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 |
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License Number State |
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