Provider Demographics
NPI:1558754747
Name:SILVER ROCK RECOVERY
Entity Type:Organization
Organization Name:SILVER ROCK RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FENNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-467-9213
Mailing Address - Street 1:4011 MCLEOD DR
Mailing Address - Street 2:BLDG A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-4305
Mailing Address - Country:US
Mailing Address - Phone:949-467-9213
Mailing Address - Fax:
Practice Address - Street 1:4011 MCLEOD DR
Practice Address - Street 2:BLDG A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-4305
Practice Address - Country:US
Practice Address - Phone:949-467-9213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility