Provider Demographics
NPI:1912319179
Name:HILLTOP RECOVERY SERVICES IOP
Entity Type:Organization
Organization Name:HILLTOP RECOVERY SERVICES IOP
Other - Org Name:HILLTOP RECOVERY SERVICES IOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:K
Authorized Official - Last Name:CARTER-RUNYON
Authorized Official - Suffix:
Authorized Official - Credentials:CSC CASII RASII
Authorized Official - Phone:707-274-5610
Mailing Address - Street 1:PO BOX 316
Mailing Address - Street 2:6300 EAST HIGHWAY 20
Mailing Address - City:LUCERNE
Mailing Address - State:CA
Mailing Address - Zip Code:95458-0316
Mailing Address - Country:US
Mailing Address - Phone:707-274-5610
Mailing Address - Fax:707-274-6609
Practice Address - Street 1:6316 E HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:LUCERNE
Practice Address - State:CA
Practice Address - Zip Code:95458-7801
Practice Address - Country:US
Practice Address - Phone:707-274-5610
Practice Address - Fax:707-600-1325
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HILLTOP RECOVERY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-22
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA170011DN261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder