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General NPI Number Information
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NPI Number | 1013456342
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Entity Type | Organization
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Legal Business Name | PACIFIC PALMS RECOVERY LLC
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Dates
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Enumeration Date | 02/20/2017
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 2215 MESA DR
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City | OCEANSIDE
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State | CA
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Zip | 92054-3707
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Country | US
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Telephone | 949-842-6007
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Fax |
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Provider Business Mailing Address
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Address Line | 3551 CAMINO MIRA COSTA SUITE T
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-3508
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RYAN SCHRIER
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Credential |
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Telephone | 949-542-0894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 370160AP
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License Number State | CA
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