Healthcare Provider Details

I. General information

NPI: 1568680338
Provider Name (Legal Business Name): ATLANTIC RECOVERY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13456 VAN NUYS BLVD
PACOIMA CA
91331
US

IV. Provider business mailing address

944 PACIFIC AVE
LONG BEACH CA
90813
US

V. Phone/Fax

Practice location:
  • Phone: 562-436-3533
  • Fax: 562-436-1007
Mailing address:
  • Phone: 562-436-3533
  • Fax: 562-436-1007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number190229AN
License Number StateCA

VIII. Authorized Official

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