MEDICARE: PRIMAVERA RECOVERY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	324500000X	Substance Abuse Rehabilitation Facility
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1194345041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMAVERA RECOVERY

Provider Business Mailing Address
First Line	:	4702 RHAPSODY DR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-2274
Country	:	US
Telephone Number	:	714-333-6425
Fax Number	:

Provider Business Practice Location Address
First Line	:	1451 QUAIL ST STE 211
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2741
Country	:	US
Telephone Number	:	714-333-6425
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LUISA CONTRERAS
Credential	:
Telephone Number	:	714-333-6425

Provider Enumeration Date	:	04/21/2020
Last Update Date	:	04/21/2020

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Directions to “PRIMAVERA RECOVERY ” Practice Location

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