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Organization
RUSS RECOVERY IOP SERVCES- PC
Active
Organization
RUSS RECOVERY IOP SERVCES- PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH CARL RUSS M.D. (MEDICAL DIRECTOR)
(760) 416-7755
Entity
Organization
Contact information
Practice address
2825 TAHQUITZ CANYON WAY, BLDG C, PALM SPRINGS, CA 92262
(866) 484-6444
(760) 416-7709
Mailing address
2825 TAHQUITZ CANYON WAY, BLDG C, PALM SPRINGS, CA 92262-7038
(866) 484-6444
(760) 416-7709
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
MFC49984
CA
Other
Enumeration date
08/16/2012
Last updated
07/02/2014
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