Basic Information
| Provider Information | |||||||||
| NPI: | 1437244159 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOODGLEN RECOVERY JUNCTION INCORPORATED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 771 W ORANGETHORPE AVE | ||||||||
| Address2: | |||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928322806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148790929 | ||||||||
| FaxNumber: | 7145782960 | ||||||||
| Practice Location | |||||||||
| Address1: | 771 W ORANGETHORPE AVE | ||||||||
| Address2: | |||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928322806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148790929 | ||||||||
| FaxNumber: | 7145782960 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | JEANIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7148796916 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | 300042AN | CA | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.