Provider Demographics
NPI:1043397029
Name:WOODGLEN RECOVERY JUNCTION
Entity Type:Organization
Organization Name:WOODGLEN RECOVERY JUNCTION
Other - Org Name:WOODGLEN DETOX
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-879-6916
Mailing Address - Street 1:751 W ORANGETHORPE AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-2806
Mailing Address - Country:US
Mailing Address - Phone:714-879-2741
Mailing Address - Fax:714-578-2960
Practice Address - Street 1:751 W ORANGETHORPE AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-2806
Practice Address - Country:US
Practice Address - Phone:714-879-2741
Practice Address - Fax:714-578-2960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300042BN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility