Provider Demographics
NPI:1710041835
Name:MIDVALLEY RECOVERY FACILITIES INC.
Entity type:Organization
Organization Name:MIDVALLEY RECOVERY FACILITIES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-674-4530
Mailing Address - Street 1:430 TEEGARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991
Mailing Address - Country:US
Mailing Address - Phone:530-674-4530
Mailing Address - Fax:530-674-4544
Practice Address - Street 1:2 9TH STREET
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5362
Practice Address - Country:US
Practice Address - Phone:530-742-6670
Practice Address - Fax:530-742-2793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA580001BN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility