| Mindful Recovery Center Inc | |
|
210 S Kenwood St Glendale CA 91205-5108 | |
| (818) 251-8024 | |
| Not Available |
| Full Name | Mindful Recovery Center Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 210 S Kenwood St, Glendale, California |
| Authorized Official Name and Position | Henry Esmailian (CEO) |
| Authorized Official Contact | 8186000060 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mindful Recovery Center Inc 2629 Foothill Blvd # 550 La Crescenta CA 91214-3511 Ph: (818) 251-8024 | Mindful Recovery Center Inc 210 S Kenwood St Glendale CA 91205-5108 Ph: (818) 251-8024 |
| NPI Number | 1922750496 |
|---|---|
| Provider Enumeration Date | 01/25/2022 |
| Last Update Date | 08/01/2022 |
| Certification Date | 08/01/2022 |
| Medicare PECOS PAC ID | 7416331129 |
|---|---|
| Medicare Enrollment ID | O20220830002054 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922750496 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Steven T Riccoboni |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1154765196 PECOS PAC ID: 8426345547 Enrollment ID: I20170215001729 |
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