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NPI Code Detail

MEDICARE: ACTIVE RECOVERY SOLUTIONS LLC

MEDICARE: ACTIVE RECOVERY SOLUTIONS 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 Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1190892APOTHERCACOMMERCIAL INSURANCES

General Provider Information

NPI Number : 1689294472
Entity Type Code : Organization
Provider Name (Legal Business Name) : ACTIVE RECOVERY SOLUTIONS LLC
Provider Business Mailing Address
First Line : 5318 ALLOTT AVE
Second Line :
City : SHERMAN OAKS
State : CA
Zip : 91401-5903
Country : US
Telephone Number : 213-858-3786
Fax Number :
Provider Business Practice Location Address
First Line : 5316 LUBAO AVE
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91364-3623
Country : US
Telephone Number : 213-858-3786
Fax Number :
Authorized Official
Title or Position : CEO
Name : MR. LONNIE MCCREERY
Credential :
Telephone Number : 213-858-3786
Provider Enumeration Date : 04/21/2020
Last Update Date : 04/21/2020

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Directions to “ACTIVE RECOVERY SOLUTIONS LLC ” Practice Location

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