MEDICARE: ATLANTIC RECOVERY SERVICES

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	251S00000X	Community/Behavioral Health Agency	190229AN	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720206584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIC RECOVERY SERVICES

Provider Business Mailing Address
First Line	:	944 PACIFIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-4228
Country	:	US
Telephone Number	:	562-436-3533
Fax Number	:	562-436-6379

Provider Business Practice Location Address
First Line	:	9722 SAN ANTONIO AVE
Second Line	:	SOUTH GATE
City	:	SOUTH GATE
State	:	CA
Zip	:	90280-4620
Country	:	US
Telephone Number	:	323-562-6925
Fax Number	:	323-563-7497

Authorized Official
Title or Position	:	DIRECTOR
Name	:	LISA CHAVEZ
Credential	:
Telephone Number	:	562-436-3533

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	08/22/2020

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