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General NPI Number Information
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NPI Number | 1831252154
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Entity Type | Organization
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Legal Business Name | HERNDON RECOVERY CENTER
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 11/09/2018
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Provider Practice Location Address
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Address Line | 7361 N SIERRA VISTA AVE
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City | FRESNO
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State | CA
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Zip | 93720-0157
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Country | US
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Telephone | 559-435-9240
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Fax | 559-435-6548
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Provider Business Mailing Address
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Address Line | 7361 N SIERRA VISTA AVE
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City | FRESNO
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State | CA
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Zip | 93720-0157
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Country | US
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Telephone | 559-435-9240
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Fax | 559-435-6548
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Authorized Official
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Title or Position | MEDICAL DIRECTOR OWNER
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Name | DR. SATNAM S ATWAL
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Credential | M.D.
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Telephone | 559-435-9240
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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 | 100074AN
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License Number State | CA
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