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General NPI Number Information
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NPI Number | 1942758909
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Entity Type | Organization
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Legal Business Name | TRUTH RECOVERY FOUNDATION
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Dates
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Enumeration Date | 09/19/2016
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Last Update Date | 09/19/2016
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Provider Practice Location Address
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Address Line | 810 PALM ST
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City | SAN JOSE
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State | CA
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Zip | 95110-3030
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Country | US
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Telephone | 408-500-6229
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Fax |
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Provider Business Mailing Address
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Address Line | 810 PALM ST
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City | SAN JOSE
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State | CA
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Zip | 95110-3030
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Country | US
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Telephone | 408-500-6229
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | WILEY DAVID THORNE
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Credential |
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Telephone | 650-703-9185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number | 430080AN
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License Number State | CA
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