Healthcare Provider Details

I. General information

NPI: 1801134564
Provider Name (Legal Business Name): SIMPLE RECOVERY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 10/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9531 NETHERWAY DR
HUNTINGTON BEACH CA
92646-6051
US

IV. Provider business mailing address

9531 NETHERWAY DR
HUNTINGTON BEACH CA
92646-6051
US

V. Phone/Fax

Practice location:
  • Phone: 949-646-3600
  • Fax:
Mailing address:
  • Phone: 949-646-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number300247AP
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number300247AP
License Number StateCA

VIII. Authorized Official

Name: MR. STEPHEN ODOM
Title or Position: ACCOUNT MANAGER
Credential:
Phone: 949-646-3600