ROUTE 66 RECOVERY PARTNERS, A MEDICAL CORPORATION (NPI# 1649648767) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649648767 |
| Entity Type | Organization |
| Organization Name | ROUTE 66 RECOVERY PARTNERS, A MEDICAL CORPORATION |
| Other Organization Name | FIRST STEP RECOVERY CENTER |
| Practice Address |
12402 Industrial Blvd Suite B-6 Victorville CA 92395-5871 |
| Mailing Address |
12402 Industrial Blvd Ste B6 Victorville CA 92395-5889 |
| Practice Telephone | 7607801237 |
| Practice Fax Number | 8777803252 |
| Mailing Telephone | 7607801237 |
| Mailing Fax Number | 8777803252 |
| Enumeration Date | 2015-09-05 |
| Last Update Date | 2019-08-10 |
| Authorized Official Name | DR. GLENN PAUL MATNEY (PRESIDENT) |
| Authorized Official Telephone | 7607801237 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
CA | Behavioral Health & Social Service Providers | |
| N | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers | ||
| N | 106H00000X | Marriage & Family Therapist | Behavioral Health & Social Service Providers | ||
| N | 207QA0401X |
Family Medicine Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 207RA0401X |
Internal Medicine Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 2083A0300X | ||||
| N | 2084A0401X |
Psychiatry & Neurology Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 2084P0802X |
Psychiatry & Neurology Specialization: Addiction Psychiatry |
Allopathic & Osteopathic Physicians | ||
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| First Step Recovery Center | Doing Business As Name - Organization |
| Street Address |
12402 INDUSTRIAL BLVD SUITE B-6 |
| City | VICTORVILLE |
| State | CA |
| Zip Code | 92395-5871 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770503575 | Clare M Matney | Family Medicine | 12402 Industrial Blvd, Suite B-6, Victorville, CA 92395-5871 | 2006-07-21 |
| 1265978738 | Paulo A Leufroy | Physical Therapist | 12402 Industrial Blvd, Suite B2, Victorville, CA 92395-5871 | 2017-01-09 |
| 1114472347 | Jeremy J Mumu | Physical Therapist | 12402 Industrial Blvd, Suite B2, Victorville, CA 92395-5871 | 2016-08-17 |
| 1154771533 | Brian Opdenhoff | Physical Therapist | 12402 Industrial Blvd, Suite B2, Victorville, CA 92395-5871 | 2016-06-16 |
| 1578922449 | Janelle C Howell | Physical Therapist | 12402 Industrial Blvd, Suite B2, Victorville, CA 92395-5871 | 2016-02-19 |
| 1194197343 | Henry Spencer Oneal | Counselor | 12402 Industrial Blvd, Suite 6, Victorville, CA 92395-5871 | 2015-10-28 |
| 1821466756 | Shailja J Patel | Physical Therapist | 12402 Industrial Blvd, Suite B2, Victorville, CA 92395-5871 | 2015-09-09 |
| 1730586959 | Rania Nehme | Physical Therapist | 12402 Industrial Blvd, Suite B2, Victorville, CA 92395-5871 | 2014-12-03 |
| 1205240454 | Ravi Patel | Physical Therapist | 12402 Industrial Blvd, Suite B2, Victorville, CA 92395-5871 | 2014-06-16 |
| 1437401197 | United Hospice, Inc. | Hospice Care, Community Based | 12402 Industrial Blvd, Suite A-7, Victorville, CA 92395-5871 | 2012-10-04 |
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| 1174019228 | Laura Mercado Halterman | Family Medicine | 16519 Victor St Ste 307, Victorville, CA 92395 | 2018-07-02 |
| 1306337829 | Stephanie Ann Kruger | Behavior Technician | Sunny Days Inc 3602 Inland Empire Blvd., Ontario, CA 92395 | 2018-05-21 |
| 1861903924 | Debra L Andersen | Clinic/Center | 12830 Hesperia Road, Suite C, D, E, Victorville, CALIFORNIA 92395 | 2017-10-17 |
| 1790202141 | Joshua Powers | Physician Assistant | 12550 Hesperia Rd Ste 101, Victorville, CA 92395 | 2017-08-26 |
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| 1447669379 | Tracie Girard | Nurse Practitioner | 17330 Bear Valley Road, Suite A106, Victorville, CA 92395 | 2014-08-05 |
| 1093153215 | Mitesh Patel | Surgery | 13010 Hesperia Rd Ste 400, Victorville, CA 92395 | 2013-06-10 |
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| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
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| City | VICTORVILLE |
| Zip Code | 92395 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.