Provider Demographics
NPI:1922420298
Name:SHAMIA RECOVERY CENTER
Entity Type:Organization
Organization Name:SHAMIA RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROOGRAM COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAIFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-644-2577
Mailing Address - Street 1:126 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-5049
Mailing Address - Country:US
Mailing Address - Phone:707-644-2577
Mailing Address - Fax:
Practice Address - Street 1:126 OHIO ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-5049
Practice Address - Country:US
Practice Address - Phone:707-644-2577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility