Healthcare Provider Details

I. General information

NPI: 1619372380
Provider Name (Legal Business Name): MYLIFE RECOVERY CENTERS, A MEDICAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 LA CASA VIA SUITE 106
WALNUT CREEK CA
94598-3013
US

IV. Provider business mailing address

10061 RIVERSIDE DR #874
TOLUCA LAKE CA
91602-2560
US

V. Phone/Fax

Practice location:
  • Phone: 925-201-6400
  • Fax: 818-736-5846
Mailing address:
  • Phone: 818-736-5836
  • Fax: 818-736-5846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALBERT LAI
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 818-736-5836