Provider Demographics
NPI:1073023107
Name:HUMBOLDT RECOVERY CENTER INC.,
Entity Type:Organization
Organization Name:HUMBOLDT RECOVERY CENTER INC.,
Other - Org Name:EUREKA 12 STEP HOUSE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KYM
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:707-443-4237
Mailing Address - Street 1:PO BOX 6310
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95502
Mailing Address - Country:US
Mailing Address - Phone:707-443-4237
Mailing Address - Fax:707-442-1191
Practice Address - Street 1:1303 11TH ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501
Practice Address - Country:US
Practice Address - Phone:707-443-4237
Practice Address - Fax:707-442-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120001DN324500000X
CA120001BN324500000X
CA120001AN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility