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
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1508517269
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	:	10700 CUSHDON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-3219
Country	:	US
Telephone Number	:	310-388-9612
Fax Number	:

Authorized Official
Title or Position	:	AVP PAYER RELATIONS & STRATEGY
Name	:	MAGDALEN GUSTILO
Credential	:
Telephone Number	:	714-568-7667

Provider Enumeration Date	:	01/14/2022
Last Update Date	:	12/30/2025

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