Provider Demographics
NPI:1922145630
Name:EATON CANYON RECOVERY SERVICES, INC.
Entity Type:Organization
Organization Name:EATON CANYON RECOVERY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CDS
Authorized Official - Phone:626-798-0150
Mailing Address - Street 1:3323 FAIRPOINT ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-1203
Mailing Address - Country:US
Mailing Address - Phone:626-798-0150
Mailing Address - Fax:626-798-8685
Practice Address - Street 1:3323 FAIRPOINT ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-1203
Practice Address - Country:US
Practice Address - Phone:626-798-0150
Practice Address - Fax:626-798-8685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190521AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility