Provider Demographics
NPI:1942602867
Name:CHICO RECOVERY CENTER
Entity Type:Organization
Organization Name:CHICO RECOVERY CENTER
Other - Org Name:NO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-343-6566
Mailing Address - Street 1:2057 FOREST AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7627
Mailing Address - Country:US
Mailing Address - Phone:530-343-6566
Mailing Address - Fax:530-343-6715
Practice Address - Street 1:2057 FOREST AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-7627
Practice Address - Country:US
Practice Address - Phone:530-343-6566
Practice Address - Fax:530-343-6715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040021AN261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder