Organization · Type 2 NPI

Synthesis Recovery LLC

Substance Abuse Rehabilitation Facility · San Jose, CA

NPI number 1174188239 Active

Practice location

5498 Blackoak Way
San Jose, CA 95129-3110

Call (833) 338-1373 Map

Mailing address

2238 Kirsten Lee Dr
Westlake Village, CA 91361-5564

Specialties and licenses

Taxonomy	Code	License
Substance Abuse Rehabilitation Facility Primary	324500000X	None listed

Substance Abuse Rehabilitation Facility: A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.

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NPI record

NPI: 1174188239
Entity type: Organization (Type 2)
Issued: May 4, 2019
Last updated: May 22, 2019
Status: Active

Other names

<unavail>
Summit Peninsula · doing business as
Summit On Peninsula · doing business as
Summit On the Peninsula · doing business as

Authorized official

Sergei Vidov
CEO
(310) 498-3626

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1174188239

Synthesis Recovery LLC's National Provider Identifier is 1174188239, issued on May 4, 2019. The primary taxonomy on file is Substance Abuse Rehabilitation Facility (324500000X), and the practice location is in San Jose, CA. The record was last updated on May 22, 2019.