Provider Demographics
NPI:1023626694
Name:MY TIME RECOVERY, LLC
Entity type:Organization
Organization Name:MY TIME RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:NYGREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-419-2592
Mailing Address - Street 1:83 E SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7620
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1015 E INDIANAPOLIS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-3819
Practice Address - Country:US
Practice Address - Phone:702-419-2592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MY TIME RECOVERY, LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-20
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility