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General NPI Number Information
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NPI Number | 1356156517
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Entity Type | Organization
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Legal Business Name | BROADVIEW RECOVERY INC
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 2009 69TH ST
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City | LEMON GROVE
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State | CA
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Zip | 91945-3409
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Country | US
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Telephone | 619-805-5105
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Fax |
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Provider Business Mailing Address
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Address Line | 7400 EL CAJON BLVD STE 302
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City | LA MESA
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State | CA
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Zip | 91942-7417
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Country | US
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Telephone | 619-805-5105
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SHIVA D'AMOND
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Credential | CADC-II
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Telephone | 619-805-5105
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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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