Organization
SOUTH LAKE TAHOE RECOVERY AND REHABILITATION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NATHAN TUDDENHAM (CHIEF OPERATING OFFICER)
(831) 740-4629
Entity
Organization
Contact information
Practice address
591 TAHOE KEYS BLVD STE D2, SOUTH LAKE TAHOE, CA 96150-3359
(530) 539-9029
Mailing address
262 GAFFEY RD, WATSONVILLE, CA 95076-9731
(831) 740-4629
(831) 708-2450
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
11/05/2018
Last updated
09/20/2022
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