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1639686728 NPI number — RECOVERY GRADS, LLC

NPI Number: 1639686728
Health Care Provider/Practitioner: RECOVERY GRADS, LLC

Information about “1639686728” NPI (RECOVERY GRADS, LLC) exists in 1639686728 in HTML format HTML  |  1639686728 in plain Text format TXT  |  1639686728 in PDF (Portable Document Format) PDF  |  1639686728 in an XML format XML  formats.

NPI Number : 1639686728 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1639686728",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "RECOVERY GRADS, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1015 GAYLEY AVE STE 203",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LOS ANGELES",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90024-3475",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "310-822-1234",
    "MailingAddressFaxNumber": "213-737-3059",
    "FirstLinePracticeLocationAddress": "1015 GAYLEY AVE STE 203",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LOS ANGELES",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90024-3475",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "310-822-1234",
    "PracticeLocationAddressFaxNumber": "213-737-3059",
    "EnumerationDate": "01/10/2018",
    "LastUpdateDate": "09/18/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LIEBHARD",
    "AuthorizedOfficialFirstName": "ELLIOT",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CFO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "917-374-4215",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261QR0405X",
          "TaxonomyName": "Substance Use Disorder Rehabilitation Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QM0850X",
          "TaxonomyName": "Adult Mental Health Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "324500000X",
          "TaxonomyName": "Substance Abuse Rehabilitation Facility",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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