Provider Demographics
NPI:1174038939
Name:BRANCHES RECOVERY CENTER
Entity Type:Organization
Organization Name:BRANCHES RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-317-5571
Mailing Address - Street 1:2279 EAGLE GLEN PKWY # 112-409
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-0790
Mailing Address - Country:US
Mailing Address - Phone:951-317-5571
Mailing Address - Fax:
Practice Address - Street 1:19905 BEDFORD CANYON RD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-4827
Practice Address - Country:US
Practice Address - Phone:951-317-5571
Practice Address - Fax:951-444-7818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-02
Last Update Date:2017-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty