Provider Demographics
NPI:1447619077
Name:THE BETHESDA RECOVERY CENTER
Entity Type:Organization
Organization Name:THE BETHESDA RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-945-5290
Mailing Address - Street 1:733 S SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-5939
Mailing Address - Country:US
Mailing Address - Phone:760-945-5290
Mailing Address - Fax:760-945-7765
Practice Address - Street 1:733 S SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-5939
Practice Address - Country:US
Practice Address - Phone:760-945-5290
Practice Address - Fax:760-945-7765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-10
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility