Provider Demographics
NPI:1831284843
Name:SPENCER RECOVERY CENTERS, INC.
Entity Type:Organization
Organization Name:SPENCER RECOVERY CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SALO GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-313-5240
Mailing Address - Street 1:PO BOX 9296
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92652-7261
Mailing Address - Country:US
Mailing Address - Phone:800-334-0394
Mailing Address - Fax:949-313-5222
Practice Address - Street 1:1316 S COAST HWY
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-3118
Practice Address - Country:US
Practice Address - Phone:800-334-0394
Practice Address - Fax:949-313-5222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300088AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ60436ZOtherBLUE SHIELD OF CA
CAZZZ60436ZOtherBLUE SHIELD OF CA
CAZZZ60436ZOtherBLUE SHIELD OF CA