Provider Demographics
NPI:1699807503
Name:BAKERSFIELD RECOVERY SERVICES, LINCOLN STREET RETREAT
Entity Type:Organization
Organization Name:BAKERSFIELD RECOVERY SERVICES, LINCOLN STREET RETREAT
Other - Org Name:C.B.C.C INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LAROQUE
Authorized Official - Suffix:
Authorized Official - Credentials:CADC II
Authorized Official - Phone:661-325-1817
Mailing Address - Street 1:708 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93305-3711
Mailing Address - Country:US
Mailing Address - Phone:661-869-1795
Mailing Address - Fax:661-869-1794
Practice Address - Street 1:708 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-3711
Practice Address - Country:US
Practice Address - Phone:661-869-1795
Practice Address - Fax:661-869-1794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA150004GN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility