Provider Demographics
NPI:1124280714
Name:CENTRAL VALLEY REGIONAL RECOVERY CENTER
Entity type:Organization
Organization Name:CENTRAL VALLEY REGIONAL RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:STARK
Authorized Official - Suffix:
Authorized Official - Credentials:MSA
Authorized Official - Phone:909-433-9824
Mailing Address - Street 1:1076 SANTO ANTONIO DR
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-8103
Mailing Address - Country:US
Mailing Address - Phone:909-433-9824
Mailing Address - Fax:909-433-9830
Practice Address - Street 1:1076 SANTO ANTONIO DR
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-8103
Practice Address - Country:US
Practice Address - Phone:909-433-9824
Practice Address - Fax:909-433-9830
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENTAL HEALTH SYSTEMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARS6544OtherCAADAC REGISTERED STUDENT