Organization
THE GATES RECOVERY FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD ST.ANDREW (CREDENTIALING SERVICES MANAGER)
(805) 778-0055
Entity
Organization
Contact information
Practice address
1864 BROADWAY, PLACERVILLE, CA 95667-6018
(530) 622-9500
(530) 622-9534
Mailing address
2810 COLOMA ST, PLACERVILLE, CA 95667-4406
(530) 622-9500
(530) 622-9534
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
090016CN
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090016CN
FACILITY LICENSE NUMBER
CA
Enumeration date
11/15/2007
Last updated
11/15/2007
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