Healing Waters Recovery, LLC Eastvale

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

201617610555 Issued in CA

Legal business name

HEALING WATERS RECOVERY, LLC EASTVALE

Practice address

13757 Aspen Leaf Lane
Eastvale, CA 92880

Phone

(772) 233-0677

NPI assigned

Sep 14, 2016

Organization subpart

Yes

Parent organization

HEALING WATERS RECOVERY ASP, LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Darlene Marie Leon

Title

President

Phone

(772) 233-0677

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1473811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473811200000",
    "number": "1023566445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19069 VAN BUREN BLVD",
            "address_2": "114 116",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "92508",
            "telephone_number": "772-233-0677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13757 ASPEN LEAF LANE",
            "city": "EASTVALE",
            "state": "CA",
            "postal_code": "92880",
            "telephone_number": "772-233-0677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALING WATERS RECOVERY, LLC EASTVALE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HEALING WATERS RECOVERY ASP, LLC",
        "enumeration_date": "2016-09-14",
        "last_updated": "2016-09-14",
        "status": "A",
        "authorized_official_last_name": "LEON",
        "authorized_official_first_name": "DARLENE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "772-233-0677",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "201617610555",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria Gutierrez-Mataro, NP
• Analyse Monique Gutierrez
• Hamner Congregate Care
• Terri Hanson, MSN, FNP-C, FNP-BC
• Jake Michael Harries, RPH
• Jennifer Lynn Henshaw, MS, LMFT
• Highview Nutrition Inc
• HK Drugs Inc (CareMore Pharmacy)
• HK Drugs Inc. (CareMore Pharmacy)
• Kimberly Thi Hoang, RN

• Substance Abuse Rehabilitation Facility in Eastvale, CA
• Providers in Eastvale, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.