Provider Demographics
NPI:1710373808
Name:ADDICTION FREE RECOVERY SERVICES
Entity Type:Organization
Organization Name:ADDICTION FREE RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:DEANNE
Authorized Official - Last Name:BLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-579-3301
Mailing Address - Street 1:2937 VENEMAN AVE STE A105
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-0639
Mailing Address - Country:US
Mailing Address - Phone:209-579-3301
Mailing Address - Fax:209-579-3311
Practice Address - Street 1:2937 VENEMAN AVE STE A105
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-0639
Practice Address - Country:US
Practice Address - Phone:209-579-3301
Practice Address - Fax:209-579-3311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-15
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder