Provider Demographics
NPI:1619178514
Name:EMPIRE HOTEL ALCOHOLIC REHABILITION INC.
Entity Type:Organization
Organization Name:EMPIRE HOTEL ALCOHOLIC REHABILITION INC.
Other - Org Name:EMPIRE OUTPATIENT SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NEALY
Authorized Official - Suffix:
Authorized Official - Credentials:CASII CADCII
Authorized Official - Phone:530-243-7470
Mailing Address - Street 1:1237 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0618
Mailing Address - Country:US
Mailing Address - Phone:530-243-7470
Mailing Address - Fax:530-243-7477
Practice Address - Street 1:5014 SHASTA DAM BLVD.
Practice Address - Street 2:
Practice Address - City:SHASTA LAKE CITY
Practice Address - State:CA
Practice Address - Zip Code:96019-0777
Practice Address - Country:US
Practice Address - Phone:530-275-1076
Practice Address - Fax:530-275-3717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA450001BN261QR0405X
CA450001AN261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder