Provider Demographics
NPI:1104171289
Name:EMPIRE HOTEL ALCOHOLIC REHABILITATION CENTER, INC.
Entity type:Organization
Organization Name:EMPIRE HOTEL ALCOHOLIC REHABILITATION CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARJEANNE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:BA, CADCII, ICADC, M
Authorized Official - Phone:530-243-7470
Mailing Address - Street 1:1237 CALIFORNIA ST.
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001
Mailing Address - Country:US
Mailing Address - Phone:530-243-7470
Mailing Address - Fax:530-243-7477
Practice Address - Street 1:1616 WEST ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1726
Practice Address - Country:US
Practice Address - Phone:530-243-7470
Practice Address - Fax:530-243-7477
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMPIRE HOTEL ALCOHOLIC REHABILITATION CENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0401X
CA450001CN261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)