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CHILDREN'S RECOVERY CENTER 1, LLC
NPI 1720597511
General Acute Care Hospital - Children in Campbell, CA

Active since September 25, 2017CLIA 05D0932970 · Waiver
3777 S BASCOM AVE, CAMPBELL, CA 95008(408) 558-3640(408) 340-1519 Get Directions Write a Review

NPPES record last updated: June 22, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jun 22, 2023, Jul 21, 2022 (2 updates tracked since 2022).

About Children's Recovery Center 1, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CHILDREN'S RECOVERY CENTER 1, LLC (NPI 1720597511) is a healthcare organization registered as a children in Campbell, California and active in the NPI registry since September 2017. The organization holds a CLIA Waiver certificate valid through May 23, 2028 and lists Dan Niccum, Ceo, as its authorized official.

NPPES Registry Identity

NPI1720597511
Entity TypeOrganization
Primary Taxonomy282NC2000X
Legal Business NameCHILDREN'S RECOVERY CENTER 1, LLC
Location Address3777 S BASCOM AVECampbell, CA 95008-7320
Mailing Address3777 S Bascom AveCampbell, CA 95008-7320 · (408) 558-3640 · Fax (408) 340-1519
Phone(408) 558-3640
Fax(408) 340-1519
Organization SubpartYesParent: Innovations Health Systems
Authorized OfficialDan NiccumCeo · (916) 425-1171
Enumeration DateSeptember 25, 2017
Last NPPES UpdateJune 22, 20232 updates tracked since enumeration
NPPES CertifiedJune 22, 2023
✔ NPI 1720597511 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral Acute Care Hospital · ChildrenHospitals
Taxonomy Code282NC2000X
3777 S BASCOM AVE, Campbell, CA 95008
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D0932970

Children's Recovery Center Laboratory · Campbell, CA
Active · expires May 23, 2028
CLIA Number05D0932970
Laboratory TypeHospital
Certificate Effective DateMay 24, 2026
Certificate Expiration DateMay 23, 2028
Laboratory DirectorRichard M. Anderson
Laboratory Phone(408) 558-3640
Laboratory LocationChildren's Recovery Center Laboratory3777 S Bascom Ave, Campbell, CA 95008
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

WINDY WAN-YI CHOU OTR/L
Occupational Therapist
3777 S BASCOM AVE
CAMPBELL, CA 95008
Santa Clara County (408) 558-3650
ASHLEY MARIAH KINARD MSOT
Occupational Therapist
3777 S BASCOM AVE
CAMPBELL, CA 95008
Santa Clara County (408) 558-3640
JD MEDICAL SERVICES
Pediatrics (Pediatric Critical Care Medicine)
3777 S BASCOM AVE
CAMPBELL, CA 95008
Santa Clara County (408) 558-3640
JOSEPH VINCENT DICARLO M.D.
Pediatrics (Pediatric Critical Care Medicine)
3777 S BASCOM AVE
CAMPBELL, CA 95008
Santa Clara County (408) 558-3640
JOSEPH DICARLO
Pediatrics (Pediatric Emergency Medicine)
3777 S BASCOM AVE
CAMPBELL, CA 95008
Santa Clara County (408) 314-3333

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Children's Recovery Center 1, LLC's NPI number?

The NPI number for Children's Recovery Center 1, LLC is 1720597511. It was assigned to this organization in the NPPES registry on September 25, 2017.

Where is Children's Recovery Center 1, LLC located?

Children's Recovery Center 1, LLC is located at 3777 S Bascom Ave, Campbell, CA 95008. The listed phone number is (408) 558-3640.

What is Children's Recovery Center 1, LLC's specialty?

The primary specialty registered for this NPI is General Acute Care Hospital, specializing in Children, with taxonomy code 282NC2000X.

Does Children's Recovery Center 1, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D0932970) is associated with this NPI, valid through May 23, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Children's Recovery Center 1, LLC was last updated on June 22, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.