Organization · NPI-2

Addiction Recovery Center

Community/Behavioral Health · San Jose, CA

NPI number1164835914

StatusActive

Last updated in NPPESJun 10, 2014

Details

NPI: 1164835914
Entity type: Organization (NPI-2)
Legal business name: Addiction Recovery Center
Organization subpart: No
Enumeration date: Jun 10, 2014
Last updated: Jun 10, 2014

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
251S00000X	Community/Behavioral Health	–	–	Yes
261QM0801X	Clinic/Center, Mental Health (Including Community Mental Health Center)	–	–

Practice location

3880 S. Bascom Ave #206
San Jose, CA 95124

Phone 408-907-3176 · Fax 408-371-9193

Mailing address

3880 S. Bascom Ave #206
San Jose, CA 95124

Phone 408-907-3176 · Fax 408-371-9193

Authorized official

Mary Anne Fifield
Ex Director
4084860110

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