Provider Demographics
NPI:1740786557
Name:MY TIME RECOVERY, LLC
Entity Type:Organization
Organization Name:MY TIME RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-355-6128
Mailing Address - Street 1:83 E SHAW AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7624
Mailing Address - Country:US
Mailing Address - Phone:559-286-9263
Mailing Address - Fax:
Practice Address - Street 1:1107 W RIALTO AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93705-0918
Practice Address - Country:US
Practice Address - Phone:559-840-0896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MY TIME RECOVERY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-02
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100002AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility