Provider Demographics
NPI:1043346067
Name:CENTRAL VALLEY RECOVERY SERVICES, INC..
Entity Type:Organization
Organization Name:CENTRAL VALLEY RECOVERY SERVICES, INC..
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:CASII
Authorized Official - Phone:559-625-2995
Mailing Address - Street 1:320 W OAK AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-4929
Mailing Address - Country:US
Mailing Address - Phone:559-625-2995
Mailing Address - Fax:559-625-3808
Practice Address - Street 1:320 W OAK AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4929
Practice Address - Country:US
Practice Address - Phone:559-625-2995
Practice Address - Fax:559-625-3808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA540031DN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA540031DNOtherPRGRAM CERTIFICATION NO.
CAC545415OtherDRUG MEDICAL BILLING NUMB