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General NPI Number Information
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NPI Number | 1801171533
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Entity Type | Organization
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Legal Business Name | RE-ENTRY INC.
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Dates
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Enumeration Date | 10/13/2011
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Last Update Date | 10/13/2011
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Provider Practice Location Address
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Address Line | 8851 GARDEN HWY
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City | YUBA CITY
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State | CA
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Zip | 95991-9433
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Country | US
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Telephone | 530-751-7561
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Fax | 530-755-1375
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Provider Business Mailing Address
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Address Line | PO BOX 6804
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City | AUBURN
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State | CA
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Zip | 95604-6804
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Country | US
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Telephone | 530-885-4509
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Fax | 530-885-4109
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. JENNIFER ANN JARAMILLO
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Credential |
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Telephone | 530-845-1131
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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 | 510003AP
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License Number State | CA
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