MEDICARE: OCEAN 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	300144AP	CA

General Provider Information

NPI Number	:	1558657809
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEAN RECOVERY, LLC

Provider Business Mailing Address
First Line	:	3419 VIA LIDO
Second Line	:	SUITE 310
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-3908
Country	:	US
Telephone Number	:	949-723-2388
Fax Number	:	949-723-1288

Provider Business Practice Location Address
First Line	:	1601 W BALBOA BLVD
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-4527
Country	:	US
Telephone Number	:	949-723-2388
Fax Number	:	949-723-1288

Authorized Official
Title or Position	:	ADMINISTRATIVE DIRECTOR
Name	:	MADDY NAHIGYAN
Credential	:
Telephone Number	:	949-524-1039

Provider Enumeration Date	:	06/24/2011
Last Update Date	:	05/27/2022

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