NPIMap

Organization Active NPI

Children's Recovery Center 1, LLC

  • Children's Hospital
  • Campbell, CA
National Provider Identifier
1720597511
Registry record updated Jun 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Children's HospitalTaxonomy code 282NC2000X
Legal business name
CHILDREN'S RECOVERY CENTER 1, LLC
Practice address
3777 S Bascom Ave
Campbell, CA 95008-7320
Phone
(408) 558-3640
Fax
(408) 340-1519
NPI assigned
Sep 25, 2017
Last updated
Jun 22, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
INNOVATIONS HEALTH SYSTEMSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 22, 2023

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

Authorized official

Name
Dan Niccum
Title
Ceo
Phone
(916) 425-1171

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Children's Hospital 282NC2000X NU Primary

Addresses

Primary practice location

3777 S Bascom Ave
Campbell, CA 95008-7320

Mailing address

3777 S Bascom Ave
Campbell, CA 95008-7320
Phone (408) 558-3640

National Provider Directory

National Provider Directory
Tax ID family
Children's Recovery Center3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1506297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687392000000",
    "number": "1720597511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3777 S BASCOM AVE",
            "city": "CAMPBELL",
            "state": "CA",
            "postal_code": "950087320",
            "telephone_number": "408-558-3640",
            "fax_number": "408-340-1519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3777 S BASCOM AVE",
            "city": "CAMPBELL",
            "state": "CA",
            "postal_code": "950087320",
            "telephone_number": "408-558-3640",
            "fax_number": "408-340-1519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S RECOVERY CENTER 1, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INNOVATIONS HEALTH SYSTEMS",
        "enumeration_date": "2017-09-25",
        "last_updated": "2023-06-22",
        "certification_date": "2023-06-22",
        "status": "A",
        "authorized_official_last_name": "NICCUM",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "916-425-1171"
    },
    "taxonomies": [
        {
            "code": "282NC2000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Children",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Campbell, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2023; 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.