Healthcare Provider Details

I. General information

NPI: 1073789087
Provider Name (Legal Business Name): ATLANTIC RECOVERY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7317 PEARBLOSSOM HWY
LITTLEROCK CA
93543-3033
US

IV. Provider business mailing address

944 PACIFIC AVE
LONG BEACH CA
90813-4228
US

V. Phone/Fax

Practice location:
  • Phone: 562-436-3533
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: LORI MILLER
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 562-436-3533