Provider Demographics
NPI:1578962114
Name:BLUESTONE RECOVERY, INC.
Entity Type:Organization
Organization Name:BLUESTONE RECOVERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:LAADAC
Authorized Official - Phone:951-536-2213
Mailing Address - Street 1:1660 CHICAGO AVE STE M11
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-2033
Mailing Address - Country:US
Mailing Address - Phone:951-823-0540
Mailing Address - Fax:951-823-0541
Practice Address - Street 1:1660 CHICAGO AVE STE M11
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2033
Practice Address - Country:US
Practice Address - Phone:951-823-0540
Practice Address - Fax:951-823-0541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA330127AP251S00000X, 261QR0405X
CA360107BP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility