Healthcare Provider Details

I. General information

NPI: 1962549295
Provider Name (Legal Business Name): RECOVERY HOMES OF AMERICA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13671 ROSALIND DR
TUSTIN CA
92780-1924
US

IV. Provider business mailing address

1950 E 17TH STREET SUITE 150
SANTA ANA CA
92705-6852
US

V. Phone/Fax

Practice location:
  • Phone: 714-547-5375
  • Fax: 714-541-3320
Mailing address:
  • Phone: 714-547-4300
  • Fax: 714-689-0012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA STONE
Title or Position: EXEC VICE PRESIDENT
Credential:
Phone: 714-547-5375