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

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	:	1891064952
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	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10720 WILMINGTON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90059-1236
Country	:	US
Telephone Number	:	562-436-3533
Fax Number	:	562-436-0043

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	LORI MILLER
Credential	:
Telephone Number	:	562-436-3533

Provider Enumeration Date	:	12/19/2011
Last Update Date	:	12/19/2011

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Directions to “ATLANTIC RECOVERY SERVICES ” Practice Location

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