Provider Demographics
NPI:1376766238
Name:J COLE RECOVERY HOMES, INC
Entity Type:Organization
Organization Name:J COLE RECOVERY HOMES, INC
Other - Org Name:COLE HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARCELLOS
Authorized Official - Suffix:
Authorized Official - Credentials:CAS
Authorized Official - Phone:925-978-2873
Mailing Address - Street 1:1408 A ST
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-2331
Mailing Address - Country:US
Mailing Address - Phone:925-978-2873
Mailing Address - Fax:925-757-0411
Practice Address - Street 1:1408 A ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-2331
Practice Address - Country:US
Practice Address - Phone:925-978-2873
Practice Address - Fax:925-757-0411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070034AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility