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General NPI Number Information
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NPI Number | 1740771070
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Entity Type | Organization
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Legal Business Name | STONE RIDGE RECOVERY INC
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Dates
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Enumeration Date | 05/22/2018
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Last Update Date | 05/22/2018
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Provider Practice Location Address
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Address Line | 24951 SANDRIDGE CIR
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-5893
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Country | US
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Telephone | 714-719-2602
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Fax |
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Provider Business Mailing Address
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Address Line | 24951 SANDRIDGE CIR
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-5893
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Country | US
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Telephone | 714-719-2602
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Fax |
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Authorized Official
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Title or Position | CEO / CHIEF EXECUTIVE OFFICER
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Name | MR. ADRIAN GONZALEZ
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Credential |
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Telephone | 714-719-2602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 300041AP
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License Number State | CA
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