Provider Demographics
NPI:1649456955
Name:ORCHID RECOVERY CENTER
Entity type:Organization
Organization Name:ORCHID RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CINELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-798-7250
Mailing Address - Street 1:1342 E 27TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-3266
Mailing Address - Country:US
Mailing Address - Phone:510-535-0611
Mailing Address - Fax:510-535-1358
Practice Address - Street 1:1342 E 27TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-3266
Practice Address - Country:US
Practice Address - Phone:510-535-0611
Practice Address - Fax:510-535-1358
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BI-BETT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA010006AN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA010006ANOtherCALIFORNIA DEPT OF ALCOHO