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General NPI Number Information
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NPI Number | 1457735714
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Entity Type | Organization
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Legal Business Name | ALTA MIRA RECOVERY CENTERS, LLC
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Dates
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Enumeration Date | 07/16/2015
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Last Update Date | 08/09/2015
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Provider Practice Location Address
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Address Line | 591 REDWOOD HWY FRONTAGE RD STE 5220
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City | MILL VALLEY
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State | CA
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Zip | 94941-3064
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Country | US
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Telephone | 415-275-7226
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Fax |
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Provider Business Mailing Address
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Address Line | 591 REDWOOD HWY FRONTAGE RD STE 5220
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City | MILL VALLEY
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State | CA
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Zip | 94941-3064
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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 | MR. WILLIAM MORRISON
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Credential |
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Telephone | 415-339-6081
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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 | 210040FP
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License Number State | CA
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