Provider Demographics
NPI:1275802977
Name:CHEROKEE RESTORATION FELLOWSHIP
Entity Type:Organization
Organization Name:CHEROKEE RESTORATION FELLOWSHIP
Other - Org Name:CHEROKEE HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DALLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:CAS
Authorized Official - Phone:530-534-3663
Mailing Address - Street 1:PO BOX 2469
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-2469
Mailing Address - Country:US
Mailing Address - Phone:530-533-5429
Mailing Address - Fax:530-533-2628
Practice Address - Street 1:141 MONO AVE
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-3309
Practice Address - Country:US
Practice Address - Phone:530-534-3663
Practice Address - Fax:530-355-5360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-26
Last Update Date:2011-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040007BN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility