Organization
CRYSTAL RIDGE RECOVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEEVAKA PRASANNA WEERASINGHE RN (PRESIDENT)
(951) 288-7962
Entity
Organization
Contact information
Practice address
2748 S ERIN WAY, SAN BERNARDINO, CA 92408-4184
(951) 288-7962
(909) 383-1388
Mailing address
2247 TIFFANY LN, COLTON, CA 92324-9246
(951) 288-7962
(909) 383-1388
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
07/27/2021
Last updated
07/27/2021
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