Provider Demographics
NPI:1164835914
Name:ADDICTION RECOVERY CENTER
Entity Type:Organization
Organization Name:ADDICTION RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EX DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FIFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DMFT, LMFT, CAS, CSA
Authorized Official - Phone:408-486-0110
Mailing Address - Street 1:3880 S. BASCOM AVE #206
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124
Mailing Address - Country:US
Mailing Address - Phone:408-907-3176
Mailing Address - Fax:408-371-9193
Practice Address - Street 1:3880 S. BASCOM AVE #206
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124
Practice Address - Country:US
Practice Address - Phone:408-907-3176
Practice Address - Fax:408-371-9193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)