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NPI Code Detail

MEDICARE: AUTHENTIC RECOVERY, LLC.

MEDICARE: AUTHENTIC RECOVERY, LLC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1324500000XSubstance Abuse Rehabilitation Facility190577APCA

General Provider Information

NPI Number : 1114173036
Entity Type Code : Organization
Provider Name (Legal Business Name) : AUTHENTIC RECOVERY, LLC.
Provider Business Mailing Address
First Line : 18401 VON KARMAN AVE STE 500
Second Line :
City : IRVINE
State : CA
Zip : 92612-8531
Country : US
Telephone Number : 714-828-1800
Fax Number : 714-882-1186
Provider Business Practice Location Address
First Line : 2203 OVERLAND AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90064-2025
Country : US
Telephone Number : 310-807-5451
Fax Number :
Authorized Official
Title or Position : AVP PAYER RELATIONS & STRATEGY
Name : MAGDALEN GUSTILO
Credential :
Telephone Number : 714-568-7667
Provider Enumeration Date : 08/12/2008
Last Update Date : 12/30/2025

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