Provider Demographics
NPI:1831252154
Name:HERNDON RECOVERY CENTER
Entity type:Organization
Organization Name:HERNDON RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SATNAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:ATWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-435-9240
Mailing Address - Street 1:7361 N SIERRA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0157
Mailing Address - Country:US
Mailing Address - Phone:559-435-9240
Mailing Address - Fax:559-435-6548
Practice Address - Street 1:7361 N SIERRA VISTA AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0157
Practice Address - Country:US
Practice Address - Phone:559-435-9240
Practice Address - Fax:559-435-6548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100074AN261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder