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General NPI Number Information
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NPI Number | 1477000776
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Entity Type | Organization
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Legal Business Name | RISING ROADS RECOVERY SERVICES FOR WOMEN, LLC
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Dates
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Enumeration Date | 09/02/2016
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 11388 SNOWDROP AVE
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-1756
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Country | US
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Telephone | 866-746-1558
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Fax | 714-786-8986
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Provider Business Mailing Address
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Address Line | 3151 AIRWAY AVE STE I3
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City | COSTA MESA
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State | CA
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Zip | 92626-4624
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Country | US
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Telephone | 949-922-1901
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Fax | 714-786-8986
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Authorized Official
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Title or Position | OPERATIONS DIRECTOR
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Name | NICOEL CAVANAGH
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Credential |
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Telephone | 949-922-1901
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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 | 300659AP
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License Number State | CA
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