Provider Demographics
NPI:1730303538
Name:CENTRAL NORTH REGIONAL RECOVERY CENTER
Entity Type:Organization
Organization Name:CENTRAL NORTH REGIONAL RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUBSTANCE ABUSE COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:ALTAMIRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-505-0228
Mailing Address - Street 1:3196 LARKDALE WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2005
Mailing Address - Country:US
Mailing Address - Phone:858-565-4026
Mailing Address - Fax:
Practice Address - Street 1:6693 CONVOY CT
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1008
Practice Address - Country:US
Practice Address - Phone:858-505-0882
Practice Address - Fax:858-505-9349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty