Healthcare Provider Details

I. General information

NPI: 1306285820
Provider Name (Legal Business Name): ALT RECOVERY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 MALL DR SUITE E
LAS CRUCES NM
88011-8194
US

IV. Provider business mailing address

1141 MALL DR SUITE E
LAS CRUCES NM
88011-8194
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-0660
  • Fax: 575-522-3151
Mailing address:
  • Phone: 575-522-0660
  • Fax: 575-522-3151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License NumberNM10059M
License Number StateNM

VIII. Authorized Official

Name: MR. STEVE LANZA
Title or Position: CEO
Credential:
Phone: 310-503-3898