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General NPI Number Information
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NPI Number | 1194217679
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Entity Type | Organization
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Legal Business Name | BAY RECOVERY SERVICES LLC
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 863 FRANCISCO BLVD E STE A
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City | SAN RAFAEL
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State | CA
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Zip | 94901-4782
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Country | US
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Telephone | 415-488-6432
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Fax |
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Provider Business Mailing Address
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Address Line | 1005 NORTHGATE DR # 174
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City | SAN RAFAEL
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State | CA
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Zip | 94903-2500
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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 | ALEXANDER VON TEMPSKY
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Credential |
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Telephone | 415-488-6432
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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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