Organization
MAYNORD'S CHEMICAL DEPENDENCY RECOVERY CENTERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
APRIL J ANTONIOU (CREDENTIALING SERVICES MANAGER)
(805) 413-1318
Entity
Organization
Contact information
Practice address
19325 CHEROKEE RD, TUOLUMNE, CA 95379-9753
(800) 228-8208
(209) 928-1152
Mailing address
3717 E THOUSAND OAKS BLVD, SUITE 266, WESTLAKE VILLAGE, CA 91362-3607
(805) 413-1318
(805) 413-1304
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
550001AP
CA
Other
Enumeration date
12/21/2006
Last updated
08/22/2020
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