| Doctor Name: | SHANNON DENISE REILLY |
| NPI Number: | 1891937306 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CAS |
| License Number: | 324500000X |
| Business Practice Address: | 5494 Pony Express Trail Pollock Pines, CA - 95726 |
| Business Phone Number: | 5306443758 |
| Business Fax Number: | 5306443782 |
| Mailing Address: | Po Box 586, CAMINO |
| State: | CA |
| Postal Code: | 957090586 |
| Phone Number: | 5306443758 |
| Fax Number: | 5306443782 |
| NPI Enumeration Date: | 03/30/2009 |
| NPI Last Update Date: | 03/30/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 324500000X |
| License Number: | 324500000X |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Substance Abuse Rehabilitation Facility |
| Taxonomy Specialization: | |
| Taxonomy Definition: | 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. |