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General NPI Number Information
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NPI Number | 1356713291
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Entity Type | Organization
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Legal Business Name | RESET RECOVERY LLC
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Dates
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Enumeration Date | 10/29/2015
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Last Update Date | 10/29/2015
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Provider Practice Location Address
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Address Line | 5156 BASCULE AVE
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City | WOODLAND HILLS
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State | CA
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Zip | 91364-3447
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Country | US
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Telephone | 747-888-9747
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Fax | 747-888-9747
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Provider Business Mailing Address
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Address Line | 5156 BASCULE AVE
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City | WOODLAND HILLS
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State | CA
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Zip | 91364-3447
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Country | US
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Telephone | 747-888-9747
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Fax | 747-888-9747
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Authorized Official
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Title or Position | CEO, PROGRAM DIRECTOR
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Name | MR. CHRIS BURKE SR.
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Credential | CADC-CAS
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Telephone | 760-845-2715
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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 | CA
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