MEDICARE: REFUGE RECOVERY CLINICAL SERVICES

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1750769428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REFUGE RECOVERY CLINICAL SERVICES

Provider Business Mailing Address
First Line	:	4302 MELROSE AVE STE B
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-3511
Country	:	US
Telephone Number	:	323-787-7077
Fax Number	:

Provider Business Practice Location Address
First Line	:	4302 MELROSE AVE STE B
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-3511
Country	:	US
Telephone Number	:	323-787-7077
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. NOAH LEVINE
Credential	:
Telephone Number	:	323-787-7077

Provider Enumeration Date	:	05/13/2015
Last Update Date	:	05/13/2015

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