Basic Information
| Provider Information | |||||||||
| NPI: | 1003206228 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HELEN VINE RECOVERY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 NORTHGATE DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | SAN RAFAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949033696 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154576964 | ||||||||
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| Practice Location | |||||||||
| Address1: | 291 SMITH RANCH RD | ||||||||
| Address2: | |||||||||
| City: | SAN RAFAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949035551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154920818 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2015 | ||||||||
| LastUpdateDate: | 05/01/2018 | ||||||||
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| AuthorizedOfficialLastName: | MENSING | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR - QUALITY & COMPLIANCE | ||||||||
| AuthorizedOfficialTelephone: | 4153021423 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BUCKELEW PROGRAMS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | 210017DN | CA | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.