Healthcare Provider Details

I. General information

NPI: 1568827418
Provider Name (Legal Business Name): RECOVERY GRADS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2015
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3077 UNIVERSITY AVE STE 105
LOS ANGELES CA
90007-3717
US

IV. Provider business mailing address

1015 GAYLEY AVE STE 203
LOS ANGELES CA
90024-3475
US

V. Phone/Fax

Practice location:
  • Phone: 310-480-7129
  • Fax: 805-584-9651
Mailing address:
  • Phone: 310-822-1234
  • Fax: 213-737-3059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELLIOT LIEBHARD
Title or Position: CFO
Credential:
Phone: 917-374-4215