1205605540 NPI number — THE RECOVERY VILLAGE CALIFORNIA, LLC

Table of content: (NPI 1043151657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205605540 NPI number — THE RECOVERY VILLAGE CALIFORNIA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE RECOVERY VILLAGE CALIFORNIA, LLC
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:
1205605540
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 N COMMERCE PKWY STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33326-3258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
754-300-3120
Provider Business Mailing Address Fax Number:
888-919-4431

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43700 CACTUS VALLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEMET
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92544-9337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-785-5520
Provider Business Practice Location Address Fax Number:
888-919-4431
Provider Enumeration Date:
12/28/2023

Additional Information

Authorized Official

Authorized Official Last Name:
SURUJON
Authorized Official First Name:
BELINA
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTRACTING & LICENSING DIRECTOR
Authorized Official Telephone Number:
305-785-5520

Provider Taxonomy Codes

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

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





Copyright © 2007-2026 www.npivalidator.com