Provider Demographics
NPI:1518401249
Name:BELGRAVE RECOVERY CENTER
Entity Type:Organization
Organization Name:BELGRAVE RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-270-1195
Mailing Address - Street 1:202 E COMMONWEALTH AVE
Mailing Address - Street 2:# 565
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92836-8600
Mailing Address - Country:US
Mailing Address - Phone:310-270-1195
Mailing Address - Fax:
Practice Address - Street 1:2668 BELGRAVE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-2934
Practice Address - Country:US
Practice Address - Phone:310-270-1195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility