Provider Demographics
NPI:1306440292
Name:CALIFORNIA PALMS ADDICTION RECOVERY CAMPUS INC.
Entity type:Organization
Organization Name:CALIFORNIA PALMS ADDICTION RECOVERY CAMPUS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:
Authorized Official - First Name:SEBASTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-262-3742
Mailing Address - Street 1:1051 N CANFIELD NILES RD
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-1110
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1051 N CANFIELD NILES RD
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-1110
Practice Address - Country:US
Practice Address - Phone:800-262-3742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALIFORNIA PALMS ADDICTION RECOVERY CAMPUS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0342236Medicaid