Healthcare Provider Details

I. General information

NPI: 1871108928
Provider Name (Legal Business Name): EXECUTIVE RECOVERY GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77725 ENFIELD LN STE 200
PALM DESERT CA
92211-0468
US

IV. Provider business mailing address

203 S ORANGE DR
LOS ANGELES CA
90036-3010
US

V. Phone/Fax

Practice location:
  • Phone: 818-299-3602
  • Fax: 805-830-1565
Mailing address:
  • Phone: 818-299-3602
  • Fax: 805-830-1565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOANN ZUNIGA
Title or Position: UR AND BILLING DIRECTOR
Credential:
Phone: 805-437-6515