Organization
CHILDREN'S RECOVERY CENTER 1, LLC
Active
Parent organization
INNOVATIONS HEALTH SYSTEMS
Organization subpart
Yes
Provider details
NPI number
Legal business name
INNOVATIONS HEALTH SYSTEMS
Authorized official
DAN NICCUM (CEO)
(916) 425-1171
Entity
Organization
Contact information
Practice address
3777 S BASCOM AVE, CAMPBELL, CA 95008-7320
(408) 558-3640
(408) 340-1519
Mailing address
3777 S BASCOM AVE, CAMPBELL, CA 95008-7320
(408) 558-3640
(408) 340-1519
Taxonomy
Speciality
Code
Description
License number
State
282NC2000X
Children's Hospital
Primary
—
—
Other
Enumeration date
09/25/2017
Last updated
06/22/2023
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