Provider Demographics
NPI:1043465008
Name:CRC HEALTH GROUP
Entity Type:Organization
Organization Name:CRC HEALTH GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:PIZANO
Authorized Official - Suffix:JR
Authorized Official - Credentials:BA
Authorized Official - Phone:619-395-2197
Mailing Address - Street 1:766 10TH ST
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:91932-2216
Mailing Address - Country:US
Mailing Address - Phone:619-395-2197
Mailing Address - Fax:
Practice Address - Street 1:1161 THIRD AVENUE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911
Practice Address - Country:US
Practice Address - Phone:619-498-8260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management