ETHRIDGE RECOVERY CENTER (NPI# 1497230429) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1497230429 |
Entity Type | Organization |
Organization Name | ETHRIDGE RECOVERY CENTER |
Practice Address |
405 63rd St San Diego CA 92114-4237 |
Practice Telephone | 6192316361 |
Mailing Telephone | 6192316361 |
Enumeration Date | 2018-09-25 |
Last Update Date | 2018-09-25 |
Authorized Official Name | MR. WILLARD RICHARD STROUD JR. (COUNSELOR) |
Authorized Official Telephone | 6192316361 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
Ambulatory Health Care Facilities |
Other Name | Type Code |
---|---|
Ethridge | Doing Business As Name - Organization |
Street Address |
405 63RD ST |
City | SAN DIEGO |
State | CA |
Zip Code | 92114-4237 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1689280422 | Jason Vince Rather | Counselor | 333 Ledgewood Lane, San Diego, San Diego, CA 92114 | 2020-09-17 |
1144882622 | Melissa Ratsamy | Peer Specialist | 286 Euclid Ave Project Enable, #102, San Diego, CA 92114 | 2019-07-03 |
1285113951 | Janet Miller | Prosthetist | 6662 Charlene Ave, San Diego, CA 92114 | 2018-08-13 |
1568828671 | Ceferina Pulgar Ruiz | General Practice | 6809 Freed Manor Lane, San Diego, CA 92114 | 2016-01-05 |
1275919227 | Susan Reyes | Registered Nurse | 802a Cardiff Street, San Diego, CA 92114 | 2015-07-31 |
1760829097 | Rea Ordono Porciuncula | Registered Nurse | 982 Worthington St., San Diego, CA 92114 | 2013-05-28 |
1912170176 | Maxine Whitfield | Specialist | 5844 Mariposa Place, San Diego, CA 92114 | 2008-04-09 |
1124210844 | Bahghi Russom Keflezighi | Family Medicine | 220 Euclid Avenue, Suite 40, San Diego, CA 92114 | 2007-08-16 |
1982701058 | Mark Leroy Dimry | Pharmacist | 286 N Euclid Ave, Semca Pharmacy, San Diego, CA 92114 | 2006-09-20 |
1649241514 | Wendy G Chacon | Pediatrics | 292 Euclid Avenue, #220, San Diego, CA 92114 | 2006-01-30 |
Find all providers in zip 92114 |
Taxonomy Code | 261QR0405X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Rehabilitation, Substance Use Disorder |
Definition to come... |
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1730552084 | San Diego Student Recovery, LLC | Clinic/Center | 5440 Morehouse Dr Ste 4500, San Diego, CA 92121-6724 | 2015-11-09 |
1841699352 | Community Behavioral Health Solutions, Inc | Clinic/Center | 7071 Consolidated Way, San Diego, CA 92121 | 2014-08-20 |
1700989829 | San Diego Health Alliance | Clinic/Center | 7545 Metropolitan Dr, San Diego, CA 92108-4402 | 2006-09-06 |
1053889634 | Crash, Inc. | Clinic/Center | 835 25th St, San Diego, CA 92102-2738 | 2018-11-13 |
Find all providers in SAN DIEGO |
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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.