Healthcare Provider Details

I. General information

NPI: 1780021071
Provider Name (Legal Business Name): PACIFIC VIEW RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 05/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

643 PACIFIC ST UNIT 1
SANTA MONICA CA
90405-2437
US

IV. Provider business mailing address

643 PACIFIC ST
SANTA MONICA CA
90405-2437
US

V. Phone/Fax

Practice location:
  • Phone: 310-392-2320
  • Fax:
Mailing address:
  • Phone: 310-392-2320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: SAM DEKIN
Title or Position: CEO
Credential: M.A.
Phone: 760-641-3972