Provider Demographics
NPI:1700650579
Name:RECOVERY CAFE SANTA CRUZ
Entity type:Organization
Organization Name:RECOVERY CAFE SANTA CRUZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SERG
Authorized Official - Middle Name:
Authorized Official - Last Name:KAGNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-222-0554
Mailing Address - Street 1:PO BOX 7841
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95061-7841
Mailing Address - Country:US
Mailing Address - Phone:831-222-0554
Mailing Address - Fax:
Practice Address - Street 1:850 FRONT STREET #7841
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95061
Practice Address - Country:US
Practice Address - Phone:831-687-8783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-13
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty