| NPI | 1659453686 |
|---|---|
| Doing Business As | 72ND AVE RECOVERY CENTER |
| Entity Type | Organization |
| Authorized Contact | LORENA LOPEZ Provider Relations Supervisor 510-337-7950 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2023-05-17 |