1699817254 NPI number — FULL SPECTRUM RECOVERY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699817254 NPI number — FULL SPECTRUM RECOVERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FULL SPECTRUM RECOVERY
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:
Provider Other Organization Name Type Code:
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:
1699817254
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 E ARRELLAGA ST
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
SANTA BARBARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93103-2274
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-966-5100
Provider Business Mailing Address Fax Number:
805-966-4980

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 E ARRELLAGA ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93103-2274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-966-5100
Provider Business Practice Location Address Fax Number:
805-966-4980
Provider Enumeration Date:
02/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GENERA
Authorized Official First Name:
DONNA GENERA
Authorized Official Middle Name:
FAYE
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
805-965-0991

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFT 22205 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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