Ethridge Recovery Center

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

ETHRIDGE RECOVERY CENTER

Practice address

405 63Rd St
San Diego, CA 92114-4237

Phone

(619) 231-6361

NPI assigned

Sep 25, 2018

Organization subpart

No

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

Authorized official

Name

Mr. Willard Richard Stroud Jr.

Title

Counselor

Phone

(619) 231-6361

Specialties & licenses 1

Addresses

Other names 1

• Ethridge Doing business as

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

{
    "created_epoch": "1537833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537833600000",
    "number": "1497230429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 63RD ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921144237",
            "telephone_number": "619-231-6361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 63RD ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921144237",
            "telephone_number": "619-231-6361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETHRIDGE RECOVERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-25",
        "last_updated": "2018-09-25",
        "status": "A",
        "authorized_official_last_name": "STROUD",
        "authorized_official_first_name": "WILLARD",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "COUNSELOR",
        "authorized_official_telephone_number": "619-231-6361",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ethridge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Etesam MD Inc
• Arshia Sean Etesam, M.D.
• Ethereal Hospice, Inc.
• Maryse S Ethier, RD
• Ethos Medical Associates P.C.
• Samatra L. Ethridge
• Michelle Etienne
• Moise Etienne, BS
• Marc Leonard Etkin, M.D.
• Susan E Etrata I

• Substance Use Disorder Rehabilitation Clinic/Center in San Diego, CA
• Providers in San Diego, CA by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2018; 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.