MY TIME RECOVERY, LLC NPI 1740786557

Substance Abuse Rehabilitation Facility in Fresno, CA

NPI 1740786557 Organization Substance Abuse Rehabilitation Facility CLIA Number 05D2156026 CLIA Certificate of Waiver

About MY TIME RECOVERY, LLC

My Time Recovery, Llc is a provider established in Fresno, California specializing in substance abuse rehabilitation facility. The NPI number of My Time Recovery, Llc is 1740786557 and was assigned on April 2018. The practitioner's primary taxonomy code is 324500000X with license number 100002AP (CA). The provider is registered as an organization and their NPI record was last updated April 2022. The authorized official of this NPI record is Samantha Barron (Office Manager)

The CLIA number of My Time Recovery, Llc is 05D2156026 registered as a "other" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to My Time Recovery, Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI

1740786557

Provider NameMY TIME RECOVERY, LLC
Provider Location Address1107 W RIALTO AVE FRESNO, CA 93705
Provider Mailing Address83 E SHAW AVE STE 200 FRESNO, CA 93710
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?Yes
Enumeration Date04-02-2018
Last Update Date04-01-2022


Primary Taxonomy

Taxonomy Code324500000X
ClassificationSubstance Abuse Rehabilitation Facility
TypeResidential Treatment Facilities
License No.100002AP
License StateCA
Taxonomy DescriptionA 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.

Business Address

MY TIME RECOVERY, LLC
1107 W RIALTO AVE
FRESNO, CA
ZIP 93705
Phone: (559) 840-0896

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Mailing Address

MY TIME RECOVERY, LLC
83 E SHAW AVE STE 200
FRESNO, CA
ZIP 93710
Phone: (559) 286-9263



Authorized Official

Authorized Official Name SAMANTHA BARRON
Authorized Official TitleOFFICE MANAGER
Authorized Official Phone(559) 355-6128

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1740786557 is:

CLIA Number05D2156026
Facility TypeOTHER
Certificate TypeCertificate of Waiver

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.