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General NPI Number Information
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NPI Number | 1407310352
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Entity Type | Organization
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Legal Business Name | RECOVERY REVELATIONS, INC.
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Dates
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Enumeration Date | 01/24/2019
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 9980 RIGGINS RD
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City | PHELAN
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State | CA
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Zip | 92371-8421
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Country | US
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Telephone | 626-696-7107
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Fax |
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Provider Business Mailing Address
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Address Line | 629 BRIGHTVIEW DR
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City | GLENDORA
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State | CA
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Zip | 91740-4145
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Country | US
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Telephone | 626-696-7107
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JOSEPH MING
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Credential |
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Telephone | 626-733-2685
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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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