MEDICARE: A BETTER CHOICE RECOVERY CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility	050004AP	CA

General Provider Information

NPI Number	:	1306113956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A BETTER CHOICE RECOVERY CENTER

Provider Business Mailing Address
First Line	:	8011 CAVE CITY RD.
Second Line	:
City	:	MOUNTAIN RANCH
State	:	CA
Zip	:	95246
Country	:	US
Telephone Number	:	209-754-0200
Fax Number	:	209-754-0210

Provider Business Practice Location Address
First Line	:	8011 CAVE CITY ROAD
Second Line	:
City	:	MOUNTAIN RANCH
State	:	CA
Zip	:	95246
Country	:	US
Telephone Number	:	209-754-0200
Fax Number	:	209-754-0210

Authorized Official
Title or Position	:	MARKETING DIRECTOR
Name	:	MRS. LESLIE ELAINE RIDEOUT
Credential	:	BA BUSINESS
Telephone Number	:	916-335-2401

Provider Enumeration Date	:	11/28/2011
Last Update Date	:	11/28/2011

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