Crystal Ridge Recovery

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

CRYSTAL RIDGE RECOVERY

Practice address

2748 S Erin Way
San Bernardino, CA 92408-4184

Phone

(951) 288-7962

Fax

(909) 383-1388

NPI assigned

Jul 27, 2021

Organization subpart

No

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

Authorized official

Name

Mr. Jeevaka Prasanna Weerasinghe, RN

Title

President

Phone

(951) 288-7962

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1627344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627344000000",
    "number": "1023781903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2247 TIFFANY LN",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923249246",
            "telephone_number": "951-288-7962",
            "fax_number": "909-383-1388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2748 S ERIN WAY",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924084184",
            "telephone_number": "951-288-7962",
            "fax_number": "909-383-1388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL RIDGE RECOVERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-27",
        "last_updated": "2021-07-27",
        "certification_date": "2021-07-27",
        "status": "A",
        "authorized_official_last_name": "WEERASINGHE",
        "authorized_official_first_name": "JEEVAKA",
        "authorized_official_middle_name": "PRASANNA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "951-288-7962",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chrystal Mye Cruz
• Jessica Cruz
• Natasha Cruz, M.S. ; MFT INTERN
• Stephanie Cruz
• Zoraya Cruz I
• Crystal'S Senior Services LLC (Crystal's Senior Services)
• Peter Csapoczi, MD
• Myriam Cubillo, LCSW
• Iliana Cuellar, D.D.S
• Moses Rueben Cuellar

• Substance Abuse Rehabilitation Facility in San Bernardino, CA
• Providers in San Bernardino, 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 Jul 27, 2021; 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.