Healthcare Provider Details

I. General information

NPI: 1306456926
Provider Name (Legal Business Name): PACIFICA RECOVERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 08/08/2020
Certification Date: 08/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74050 ALESSANDRO DR STE B
PALM DESERT CA
92260-3705
US

IV. Provider business mailing address

280 E MEL AVE
PALM SPRINGS CA
92262-4817
US

V. Phone/Fax

Practice location:
  • Phone: 760-318-0626
  • Fax: 760-318-0610
Mailing address:
  • Phone: 760-318-0626
  • Fax: 760-318-0610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. YOGESH DESAI
Title or Position: CEO
Credential:
Phone: 760-318-0626