Organization
PROJECT RECOVERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES JACKSON (CCO)
(480) 787-1591
Entity
Organization
Contact information
Practice address
9760 BIRCH CANYON PL, SAN DIEGO, CA 92126-1076
(760) 581-4357
Mailing address
2411 FENTON ST STE 103, CHULA VISTA, CA 91914-3517
(760) 581-4357
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
02/16/2023
Last updated
09/03/2024
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