Healthcare Provider Details

I. General information

NPI: 1720206584
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: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9722 SAN ANTONIO AVE SOUTH GATE
SOUTH GATE CA
90280-4620
US

IV. Provider business mailing address

944 PACIFIC AVE
LONG BEACH CA
90813-4228
US

V. Phone/Fax

Practice location:
  • Phone: 323-562-6925
  • Fax: 323-563-7497
Mailing address:
  • Phone: 562-436-3533
  • Fax: 562-436-6379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number190229AN
License Number StateCA

VIII. Authorized Official

Name: LISA CHAVEZ
Title or Position: DIRECTOR
Credential:
Phone: 562-436-3533