Basic Information
| Provider Information | |||||||||
| NPI: | 1679802789 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CRC HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7020 FRIARS ROAD | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6197189890 | ||||||||
| FaxNumber: | 6197189897 | ||||||||
| Practice Location | |||||||||
| Address1: | 7020 FRIARS ROAD | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6197189890 | ||||||||
| FaxNumber: | 6197189897 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2009 | ||||||||
| LastUpdateDate: | 12/18/2009 | ||||||||
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| AuthorizedOfficialLastName: | HASTINGS | ||||||||
| AuthorizedOfficialFirstName: | RICK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6198438067 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MA CADAAC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2800X | 101YA0400X | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Methadone Clinic | 302R00000X | RI-B0911020953 | CA | Y | Managed Care Organizations | Health Maintenance Organization |
No ID Information.