Provider Demographics
NPI:1477700540
Name:COMMUNITY RECOVERY RESOURCES
Entity Type:Organization
Organization Name:COMMUNITY RECOVERY RESOURCES
Other - Org Name:FULL CIRCLE ADOLESCENT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-273-9541
Mailing Address - Street 1:PO BOX 6028
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95604-6028
Mailing Address - Country:US
Mailing Address - Phone:530-878-5166
Mailing Address - Fax:916-797-8979
Practice Address - Street 1:730 SUNRISE AVE
Practice Address - Street 2:250
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4567
Practice Address - Country:US
Practice Address - Phone:916-787-4357
Practice Address - Fax:916-787-4359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA310017AN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health