WELLNESS RECOVERY RETREAT CENTER (NPI# 1477192813) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477192813 |
| Entity Type | Organization |
| Organization Name | WELLNESS RECOVERY RETREAT CENTER |
| Practice Address |
1562 Meridian Ave San Jose CA 95125-5319 |
| Mailing Address |
10615 Crothers Rd San Jose CA 95127-1728 |
| Practice Telephone | 8557623797 |
| Practice Fax Number | 4083514494 |
| Mailing Telephone | 4084785806 |
| Mailing Fax Number | 4083514494 |
| Enumeration Date | 2020-01-02 |
| Last Update Date | 2020-01-02 |
| Authorized Official Name | TIFFANY DOUGLASS (FOUNDER) |
| Authorized Official Telephone | 4083898346 |
| Authorized Official Credential | MA, DR. (HC) |
| Is Organization Subpart | Y |
| Parent Organization Name | WELLNESS RECOVERY RETREAT CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0401X |
Clinic/Center Specialization: Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Wellness Retreat IOP | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760850945 | Wellness Recovery Retreat Center | Substance Abuse Rehabilitation Facility | 10615 Crothers Rd, San Jose, CA 95127-1728 | 2015-09-04 |
| Street Address |
1562 MERIDIAN AVE |
| City | SAN JOSE |
| State | CA |
| Zip Code | 95125-5319 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285245431 | Carmen J. Frank | Marriage & Family Therapist | 913 Willow St., Suite 103, San Jose, CA 95125 | 2020-08-12 |
| 1376197848 | Mariam Samir Abadir | Dentist | 1670 Westwood Dr. Suite K, San Jose, CA 95125 | 2019-08-01 |
| 1750870747 | Gertrud Stojancic | Massage Therapist | 3315 Almaden Expressway, # 27/29, San Jose, CA 95125 | 2018-05-04 |
| 1659809259 | Edward Escoto | Assistant Behavior Analyst | 2075 Lincoln Ave Ste D, San Jose, CA 95125 | 2017-05-25 |
| 1104288422 | Kristin Ann Dessau | Counselor | 1261 Lincoln Avenue, Suite 202, San Jose, CA 95125 | 2016-03-25 |
| 1275964488 | Indian Health Center of Santa Clara Valley | Clinic/Center | 1685 Westwood Dr Ste 1, San Jose, CA 95125 | 2013-12-13 |
| 1598042905 | Walgreens | Exclusive Provider Organization | 2585 Almaden Road, San Jose, CA 95125 | 2011-11-14 |
| 1881981488 | Kevin Jia-chian Yen | Dentist | 1660 Willow St Ste 5, San Jose, CA 95125 | 2011-07-02 |
| 1699093724 | Lokahi Acupuncture, Inc. | Acupuncturist | 1688 Willow Street, Suite B, San Jose, CA 95125 | 2010-05-13 |
| 1538482468 | Mark Lucius Yoslow | Psychologist | 970 Minnesota Avenue, San Jose, CA 95125 | 2010-03-06 |
| Find all providers in zip 95125 | ||||
| Taxonomy Code | 261QR0401X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
| Definition to come... |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.