1821126939 NPI number — SOCIAL MODEL RECOVERY SYSTEMS, INC.

Table of content: (NPI 1821126939)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821126939 NPI number — SOCIAL MODEL RECOVERY SYSTEMS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOCIAL MODEL RECOVERY SYSTEMS, 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:
THE RIVER COMMUNITY
Provider Other Organization Name Type Code:
5
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:
1821126939
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
223 E ROWLAND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COVINA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91723-3147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-332-3145
Provider Business Mailing Address Fax Number:
626-974-4164

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23701 E EAST FORK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AZUSA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91702-1477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-250-3291
Provider Business Practice Location Address Fax Number:
626-910-1380
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HALE
Authorized Official First Name:
LYNETTA
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR DIRECTOR OF CLINICAL SERVICE
Authorized Official Telephone Number:
626-332-3145

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01839001 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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