Basic Information
| Provider Information | |||||||||
| NPI: | 1467799759 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMERICAN RECOVERY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2180 VALLEY BLVD | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917683325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098652336 | ||||||||
| FaxNumber: | 9098653496 | ||||||||
| Practice Location | |||||||||
| Address1: | 2180 VALLEY BLVD | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917683325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098652336 | ||||||||
| FaxNumber: | 9098653496 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2013 | ||||||||
| LastUpdateDate: | 01/07/2013 | ||||||||
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| AuthorizedOfficialLastName: | CANON | ||||||||
| AuthorizedOfficialFirstName: | TERI | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3106799126 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BEHAVIORAL HEALTH SERVICES | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3245S0500X | 190007MN | CA | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children |
No ID Information.