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General NPI Number Information
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NPI Number | 1710411483
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Entity Type | Organization
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Legal Business Name | RECOVERY BAY REHABILITATION CENTER
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Dates
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Enumeration Date | 04/19/2017
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Last Update Date | 04/19/2017
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Provider Practice Location Address
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Address Line | 10002 BRILEY WAY
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City | VILLA PARK
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State | CA
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Zip | 92861-4219
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Country | US
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Telephone | 949-887-6379
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Fax |
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Provider Business Mailing Address
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Address Line | 8 CHESHIRE CT
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-4210
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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 | IZZY HIRSON
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Credential |
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Telephone | 949-887-6379
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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 | 300300BP
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License Number State | CA
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