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General NPI Number Information
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NPI Number | 1689180499
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Entity Type | Organization
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Legal Business Name | MONTEREY BAY RECOVERY AND REHABILITATION, LLC
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Dates
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Enumeration Date | 12/18/2017
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Last Update Date | 09/20/2022
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Provider Practice Location Address
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Address Line | 9057 SOQUEL DRIVE BUILDING A, SUITE G
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City | APTOS
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State | CA
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Zip | 95003
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Country | US
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Telephone | 855-734-2207
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Fax |
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Provider Business Mailing Address
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Address Line | 262 GAFFEY RD
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City | WATSONVILLE
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State | CA
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Zip | 95076-9731
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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 | CHIEF OPERATING OFFICER
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Name | MR. NATHAN TUDDENHAM
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Credential | CADC-CS CA
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Telephone | 831-740-4629
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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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