Healthcare Provider Details

I. General information

NPI: 1861051799
Provider Name (Legal Business Name): PILLARS RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 NEWPORT BLVD
COSTA MESA CA
92627-3714
US

IV. Provider business mailing address

PO BOX 986
CORONA DEL MAR CA
92625-5986
US

V. Phone/Fax

Practice location:
  • Phone: 949-548-2700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: PETER GATES
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 949-701-1959