MEDICARE: CALIFORNIA PRIME RECOVERY SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1225481419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALIFORNIA PRIME RECOVERY SERVICES INC

Provider Business Mailing Address
First Line	:	17330 NEWHOPE ST STE A
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-4225
Country	:	US
Telephone Number	:	949-510-3358
Fax Number	:

Provider Business Practice Location Address
First Line	:	17330 NEWHOPE ST STE A
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-4225
Country	:	US
Telephone Number	:	949-510-3358
Fax Number	:	714-434-8034

Authorized Official
Title or Position	:	CEO
Name	:	STEPHEN MICHAEL CARMEL
Credential	:
Telephone Number	:	949-510-3358

Provider Enumeration Date	:	07/22/2016
Last Update Date	:	10/16/2023

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