Provider Demographics
NPI:1679053037
Name:RRWC, INC.
Entity Type:Organization
Organization Name:RRWC, INC.
Other - Org Name:THE RETREAT RECOVERY AND WELLNESS CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:TELIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, AMFT
Authorized Official - Phone:866-358-3988
Mailing Address - Street 1:1822 E ROUTE 66 STE A255
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-3801
Mailing Address - Country:US
Mailing Address - Phone:866-358-3988
Mailing Address - Fax:
Practice Address - Street 1:364 VERDUGO AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-3976
Practice Address - Country:US
Practice Address - Phone:866-358-3988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190096AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility