Organization
209 RECOVERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT SAMPLE (AUTHORIZED OFFICIAL)
(559) 231-2700
Entity
Organization
Contact information
Practice address
1101 STANDIFORD AVE # D1B, MODESTO, CA 95350-0982
(559) 231-2700
Mailing address
2915 RED HILL AVE STE A200, COSTA MESA, CA 92626-7978
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
06/28/2024
Last updated
06/28/2024
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