Provider Demographics
NPI:1356762264
Name:UNIDOS RECOVERY HOME
Entity type:Organization
Organization Name:UNIDOS RECOVERY HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LEE
Authorized Official - Suffix:II
Authorized Official - Credentials:CSC
Authorized Official - Phone:714-531-4624
Mailing Address - Street 1:9842 13TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-3171
Mailing Address - Country:US
Mailing Address - Phone:714-531-4624
Mailing Address - Fax:714-531-1189
Practice Address - Street 1:9842 13TH ST STE B
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-3171
Practice Address - Country:US
Practice Address - Phone:714-531-4624
Practice Address - Fax:714-531-1189
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALIFORNIA HISPANIC COMMISION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9423001551324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility