Healthcare Provider Details

I. General information

NPI: 1417261983
Provider Name (Legal Business Name): SOCIAL MODEL RECOVERY SYSTEMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4626 NORTH GRAND AVE
COVINA CA
91724-2055
US

IV. Provider business mailing address

4626 N GRAND AVE
COVINA CA
91724-2055
US

V. Phone/Fax

Practice location:
  • Phone: 626-331-5316
  • Fax: 626-332-2219
Mailing address:
  • Phone: 626-331-5316
  • Fax: 626-332-2219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LYNETTA LOUISE HALE
Title or Position: SENIOR DIRECTOR, CLINICAL SERVICES
Credential: MA, LMFT, LPT
Phone: 626-332-3145