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General NPI Number Information
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NPI Number | 1194345041
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Entity Type | Organization
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Legal Business Name | PRIMAVERA RECOVERY
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Dates
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Enumeration Date | 04/21/2020
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Last Update Date | 04/21/2020
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Provider Practice Location Address
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Address Line | 1451 QUAIL ST STE 211
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-2741
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Country | US
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Telephone | 714-333-6425
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Fax |
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Provider Business Mailing Address
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Address Line | 4702 RHAPSODY DR
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92649-2274
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Country | US
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Telephone | 714-333-6425
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LUISA CONTRERAS
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Credential |
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Telephone | 714-333-6425
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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