Provider Demographics
NPI:1831696038
Name:CALIFORNIA INTEGRATIVE RECOVERY CENTERS, LLC
Entity type:Organization
Organization Name:CALIFORNIA INTEGRATIVE RECOVERY CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-392-0241
Mailing Address - Street 1:2554 S ARGYLE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-8826
Mailing Address - Country:US
Mailing Address - Phone:559-392-0241
Mailing Address - Fax:
Practice Address - Street 1:55 SHAW AVE STE 212
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-3819
Practice Address - Country:US
Practice Address - Phone:559-392-0241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health