Provider Demographics
NPI:1851550362
Name:RECOVERY CONNECTIONS TREATMENT SERVICES
Entity Type:Organization
Organization Name:RECOVERY CONNECTIONS TREATMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:IVEY
Authorized Official - Middle Name:IKE
Authorized Official - Last Name:GROZIER
Authorized Official - Suffix:III
Authorized Official - Credentials:MA, CADCA
Authorized Official - Phone:408-264-9200
Mailing Address - Street 1:1723 HAMILTON AVE STE D
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5428
Mailing Address - Country:US
Mailing Address - Phone:408-264-9200
Mailing Address - Fax:408-264-9209
Practice Address - Street 1:1723 HAMILTON AVE STE D
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5428
Practice Address - Country:US
Practice Address - Phone:408-264-9200
Practice Address - Fax:408-264-9209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA430057BP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility