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General NPI Number Information
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NPI Number | 1740786557
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Entity Type | Organization
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Legal Business Name | MY TIME RECOVERY, LLC
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Dates
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Enumeration Date | 04/02/2018
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Last Update Date | 04/01/2022
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Provider Practice Location Address
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Address Line | 1107 W RIALTO AVE
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City | FRESNO
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State | CA
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Zip | 93705-0918
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Country | US
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Telephone | 559-840-0896
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Fax |
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Provider Business Mailing Address
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Address Line | 83 E SHAW AVE STE 200
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City | FRESNO
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State | CA
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Zip | 93710-7624
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Country | US
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Telephone | 559-286-9263
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SAMANTHA BARRON
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Credential |
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Telephone | 559-355-6128
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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 | 100002AP
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License Number State | CA
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