Provider Demographics
NPI:1851423560
Name:BAKERSFIELD RECOVERY SERVICES, INC. JASON RETREAT OUTPATIENT
Entity Type:Organization
Organization Name:BAKERSFIELD RECOVERY SERVICES, INC. JASON RETREAT OUTPATIENT
Other - Org Name:BAKERSFIELD RECOVERY SERVICES, ADMINISTRATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LAROQUE
Authorized Official - Suffix:
Authorized Official - Credentials:CADC II
Authorized Official - Phone:661-325-1817
Mailing Address - Street 1:PO BOX 3218
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93385-3218
Mailing Address - Country:US
Mailing Address - Phone:661-325-1817
Mailing Address - Fax:661-325-3929
Practice Address - Street 1:531 KNOTTS
Practice Address - Street 2:A, B
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-3018
Practice Address - Country:US
Practice Address - Phone:661-325-1817
Practice Address - Fax:661-325-3929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA150004CN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility