Provider Demographics
NPI:1760850945
Name:WELLNESS RECOVERY RETREAT CENTER
Entity Type:Organization
Organization Name:WELLNESS RECOVERY RETREAT CENTER
Other - Org Name:WELLNESS RETREAT RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-762-3797
Mailing Address - Street 1:25971 MAR VISTA CT
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95033-8026
Mailing Address - Country:US
Mailing Address - Phone:855-762-3797
Mailing Address - Fax:408-351-4494
Practice Address - Street 1:25971 MAR VISTA CT
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95033-8026
Practice Address - Country:US
Practice Address - Phone:855-762-3797
Practice Address - Fax:408-351-4494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-04
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA430084APOtherCALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES