Organization
COMMON ROAD TO RECOVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JORGE PENA (DIRECTOR)
(319) 202-1509
Entity
Organization
Contact information
Practice address
4403 1ST AVE SE STE 302, CEDAR RAPIDS, IA 52402-3221
(319) 423-0919
Mailing address
4403 1ST AVE SE STE 302, CEDAR RAPIDS, IA 52402-3221
(319) 423-0919
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1370
IA
Other
Enumeration date
07/02/2015
Last updated
07/06/2015
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