=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306456926
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PACIFICA RECOVERY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2020
-----------------------------------------------------
Last Update Date | 08/08/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 74050 ALESSANDRO DR STE B
-----------------------------------------------------
City | PALM DESERT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92260-3705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-318-0626
-----------------------------------------------------
Fax | 760-318-0610
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 280 E MEL AVE
-----------------------------------------------------
City | PALM SPRINGS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92262-4817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-318-0626
-----------------------------------------------------
Fax | 760-318-0610
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. YOGESH DESAI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 760-318-0626
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 276400000X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------