Healthcare Provider Details

I. General information

NPI: 1497227920
Provider Name (Legal Business Name): OCEAN RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2018
Last Update Date: 12/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 W BALBOA BLVD 205
NEWPORT BEACH CA
92663-9266
US

IV. Provider business mailing address

111 N SEPULVEDA BLVD STE 336
MANHATTAN BEACH CA
90266-6849
US

V. Phone/Fax

Practice location:
  • Phone: 949-675-3764
  • Fax:
Mailing address:
  • Phone: 310-625-0659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health 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: KATHY TUNNEY
Title or Position: OWNER
Credential:
Phone: 310-625-0659