ETHRIDGE RECOVERY CENTER


Address: 405 63rd St, San Diego, CA 92114-4237
Phone: 6192316361

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QR0405X Clinic/Center
Specialization: Rehabilitation, Substance Use Disorder
Ambulatory Health Care Facilities

Other Provider/Organization Names

Other Name Type Code
Ethridge Doing Business As Name - Organization

Office Location

Street Address 405 63RD ST
City SAN DIEGO
State CA
Zip Code 92114-4237

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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
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Taxonomy Information

Taxonomy Code 261QR0405X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Rehabilitation, Substance Use Disorder

Taxonomy Definition

Definition to come...

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1124539960 Crash, Inc. Clinic/Center 835 25th St, San Diego, CA 92102-2738 2017-10-19
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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
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Competitor

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City SAN DIEGO
Zip Code 92114

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Dataset Information

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.

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