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General NPI Number Information
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NPI Number | 1710355847
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Entity Type | Organization
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Legal Business Name | PACIFIC CARE RECOVERY CENTER
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Dates
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Enumeration Date | 09/06/2015
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Last Update Date | 09/06/2015
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Provider Practice Location Address
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Address Line | 6920 VICTORIA AVE #19
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City | HIGHLAND
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State | CA
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Zip | 92346-2971
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Country | US
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Telephone | 562-481-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 6920 VICTORIA AVE #19
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City | HIGHLAND
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State | CA
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Zip | 92346-2971
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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 | DIRECTOR
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Name | MS. THORIYA NAKOULA
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Credential |
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Telephone | 562-481-7100
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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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