Organization
MY TIME RECOVERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMANTHA BARRON (OFFICE MANAGER)
(559) 355-6128
Entity
Organization
Contact information
Practice address
83 E SHAW AVE STE 200-204, FRESNO, CA 93710-7620
(559) 840-0896
(559) 282-3102
Mailing address
83 E SHAW AVE STE 202, FRESNO, CA 93710-7616
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100002BP
DHCS
CA
Enumeration date
11/17/2017
Last updated
04/01/2022
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