Provider Demographics
NPI:1306603774
Name:RECOVERY ROAD RUNNERS NONPROFIT ORGANIZATION
Entity type:Organization
Organization Name:RECOVERY ROAD RUNNERS NONPROFIT ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAZIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-441-0083
Mailing Address - Street 1:3110 DUNCAN RD UNIT 327
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6846
Mailing Address - Country:US
Mailing Address - Phone:805-441-0083
Mailing Address - Fax:
Practice Address - Street 1:3110 DUNCAN RD UNIT 327
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-6846
Practice Address - Country:US
Practice Address - Phone:805-441-0083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service