Basic Information
| Provider Information | |||||||||
| NPI: | 1780043455 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTRAL VALLEY RECOVERY SERVICES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NEW HEIGHTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1731 W WALNUT AVE | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932776232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597324885 | ||||||||
| FaxNumber: | 5597328289 | ||||||||
| Practice Location | |||||||||
| Address1: | 1731 W WALNUT AVE | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932776232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597324885 | ||||||||
| FaxNumber: | 5597328289 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2016 | ||||||||
| LastUpdateDate: | 03/21/2016 | ||||||||
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| AuthorizedOfficialLastName: | KLUVER | ||||||||
| AuthorizedOfficialFirstName: | SHIRLEY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5596252995 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CATC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | 540031EN | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
ID Information
| ID | Type | State | Issuer | Description | 540031EN | 01 | CA | STATE OF CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES LICENSE AND CERTIFICATION | OTHER |