Organization
SIERRA RECOVERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BETSY FEDOR (EXECUTIVE DIRECTOR)
(530) 541-5190
Entity
Organization
Contact information
Practice address
1137 EMERALD BAY RD, SOUTH LAKE TAHOE, CA 96150-6207
(530) 541-5190
(530) 541-6031
Mailing address
1137 EMERALD BAY RD, SOUTH LAKE TAHOE, CA 96150-6207
(530) 541-5190
(530) 541-6031
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090924
SUBSTANCE ABUSE
CA
Enumeration date
01/14/2008
Last updated
01/14/2008
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