1962549295 NPI number — RECOVERY HOMES OF AMERICA INC

Table of content: (NPI 1962549295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962549295 NPI number — RECOVERY HOMES OF AMERICA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RECOVERY HOMES OF AMERICA INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CORNERSTONE OF SOUTHERN CALIFORNIA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962549295
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1950 E 17TH STREET
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
SANTA ANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92705-6852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-547-4300
Provider Business Mailing Address Fax Number:
714-689-0012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13671 ROSALIND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUSTIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92780-1924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-547-5375
Provider Business Practice Location Address Fax Number:
714-541-3320
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STONE
Authorized Official First Name:
SAMANTHA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXEC VICE PRESIDENT
Authorized Official Telephone Number:
714-547-5375

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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