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General NPI Number Information
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NPI Number | 1992159495
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Entity Type | Organization
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Legal Business Name | LANDMARK RECOVERY, LLC
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Dates
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Enumeration Date | 04/20/2016
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Last Update Date | 03/01/2017
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Provider Practice Location Address
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Address Line | 23265 S POINTE DR SUITE 101
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-1472
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Country | US
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Telephone | 888-792-9170
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Fax | 888-972-2681
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Provider Business Mailing Address
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Address Line | 23265 S POINTE DR SUITE 101
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-1472
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Country | US
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Telephone | 888-792-9170
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Fax | 888-972-2681
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | ANDREW REVILLE
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Credential |
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Telephone | 888-792-9170
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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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