Healthcare Provider Details

I. General information

NPI: 1396212262
Provider Name (Legal Business Name): T & D RECOVERY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24432 MUIRLANDS BLVD STE 223
LAKE FOREST CA
92630-3951
US

IV. Provider business mailing address

24432 MUIRLANDS BLVD STE 223
LAKE FOREST CA
92630-3951
US

V. Phone/Fax

Practice location:
  • Phone: 949-606-4681
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TYLER MICHAELIS
Title or Position: CEO
Credential:
Phone: 949-606-4681