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General NPI Number Information
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NPI Number | 1700940558
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Entity Type | Organization
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Legal Business Name | CHILDREN'S RECOVERY CENTER 2, LLC
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 13425 SOUSA LANE
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City | SARATOGA
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State | CA
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Zip | 95070
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Country | US
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Telephone | 408-340-1568
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Fax | 408-866-8144
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Provider Business Mailing Address
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Address Line | 13425 SOUSA LANE
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City | SARATOGA
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State | CA
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Zip | 95070
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Country | US
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Telephone | 408-340-1568
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Fax | 408-866-8144
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. KENNETH SHAWN MCGUIRE
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Credential |
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Telephone | 408-340-1568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2278S1500X
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Taxonomy Name | SNF/Subacute Care Certified Respiratory Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2278S1500X
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Taxonomy Name | SNF/Subacute Care Certified Respiratory Therapist
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License Number | 220000426
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License Number State | CA
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