| NPI | 1942702055 |
|---|---|
| Doing Business As | PHOENIX RISING RECOVERY IOP |
| Doing Business As | PHOENIX RISING RECOVERY |
| Other Name | THE LAKE |
| Entity Type | Organization |
| Authorized Contact | AMY CRICHTON Executive Director 760-200-3839 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: CA 330143BP) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty (Licence: CA 330143BP) |
| Enumeration Date | 2018-03-05 |
| Last Update Date | 2018-08-07 |