Provider Demographics
NPI:1720272586
Name:ADVANCED HYPERBARIC RECOVERY, INC
Entity Type:Organization
Organization Name:ADVANCED HYPERBARIC RECOVERY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:THILL
Authorized Official - Suffix:
Authorized Official - Credentials:EMT, CHT
Authorized Official - Phone:415-785-8652
Mailing Address - Street 1:1118 IRWIN ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3322
Mailing Address - Country:US
Mailing Address - Phone:415-785-8652
Mailing Address - Fax:415-785-8697
Practice Address - Street 1:1118 IRWIN ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3322
Practice Address - Country:US
Practice Address - Phone:415-785-8652
Practice Address - Fax:415-785-8697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207PE0005X
CA200422610009261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Single Specialty