Basic Information
| Provider Information | |||||||||
| NPI: | 1215920921 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SACRAMENTO RECOVERY HOUSE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2921 FULTON AVE | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958214909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163389460 | ||||||||
| FaxNumber: | 9163389468 | ||||||||
| Practice Location | |||||||||
| Address1: | 1914 22ND ST | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958167109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164556258 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2005 | ||||||||
| LastUpdateDate: | 08/13/2007 | ||||||||
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| AuthorizedOfficialLastName: | BLACKSHER | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9163389460 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | 340009AN | CA | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.