Provider Demographics
NPI:1275013856
Name:SUCCESS IN RECOVERY, INC
Entity Type:Organization
Organization Name:SUCCESS IN RECOVERY, INC
Other - Org Name:SUCCESS IN RECOVERY II
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HARNESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-635-4780
Mailing Address - Street 1:PO BOX 2556
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93279-2556
Mailing Address - Country:US
Mailing Address - Phone:559-635-4780
Mailing Address - Fax:559-635-4790
Practice Address - Street 1:3424 W PACKWOOD AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-5000
Practice Address - Country:US
Practice Address - Phone:559-635-4780
Practice Address - Fax:559-635-4790
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUCCESS IN RECOVERY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-14
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA547202724322D00000X
322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children