Healthcare Provider Details

I. General information

NPI: 1215412879
Provider Name (Legal Business Name): PACIFIC RECOVERY SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2018
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7966 BEVERLY BLVD FL 2
LOS ANGELES CA
90048-4511
US

IV. Provider business mailing address

7966 BEVERLY BLVD STE 102
LOS ANGELES CA
90048-4511
US

V. Phone/Fax

Practice location:
  • Phone: 918-804-7684
  • Fax:
Mailing address:
  • Phone: 918-804-7684
  • 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: JUSTIN WHITE
Title or Position: CEO
Credential:
Phone: 310-892-6295