Provider Demographics
NPI:1164990743
Name:HERNDON RECOVERY CENTER
Entity Type:Organization
Organization Name:HERNDON RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SATNAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:ATWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-298-5111
Mailing Address - Street 1:7055 N CHESTNUT AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0350
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7055 N CHESTNUT AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0350
Practice Address - Country:US
Practice Address - Phone:559-435-9240
Practice Address - Fax:559-435-6548
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1831252154
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility