Provider Demographics
NPI:1164837670
Name:ALTADENA RECOVERY CENTER
Entity Type:Organization
Organization Name:ALTADENA RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:RAS
Authorized Official - Phone:661-974-5285
Mailing Address - Street 1:3025 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-4534
Mailing Address - Country:US
Mailing Address - Phone:626-765-6905
Mailing Address - Fax:626-765-6905
Practice Address - Street 1:3025 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-4534
Practice Address - Country:US
Practice Address - Phone:626-765-6905
Practice Address - Fax:626-765-6905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management