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General NPI Number Information
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NPI Number | 1306621917
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Entity Type | Organization
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Legal Business Name | BOYD RECOVERY LLC
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Dates
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Enumeration Date | 08/30/2023
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 6 PETALUMA BLVD N STE A7&A8
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City | PETALUMA
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State | CA
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Zip | 94952-3050
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Country | US
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Telephone | 714-642-2404
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Fax |
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Provider Business Mailing Address
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Address Line | 6 PETALUMA BLVD N STE A7
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City | PETALUMA
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State | CA
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Zip | 94952-3027
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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 | COMPLIANCE DIRECTOR
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Name | BRANDON MARTIN
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Credential |
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Telephone | 714-916-6681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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