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NPI Code Detail

MEDICARE: SOCIAL MODEL RECOVERY SYSTEMS, INC.

MEDICARE: SOCIAL MODEL RECOVERY SYSTEMS, INC.
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

General Provider Information

NPI Number : 1821086976
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOCIAL MODEL RECOVERY SYSTEMS, INC.
Provider Business Mailing Address
First Line : 223 E ROWLAND ST
Second Line :
City : COVINA
State : CA
Zip : 91723-3147
Country : US
Telephone Number : 626-332-3145
Fax Number : 626-974-4164
Provider Business Practice Location Address
First Line : 360 S WESTLAKE AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90057-2906
Country : US
Telephone Number : 213-483-9201
Fax Number : 213-353-1740
Authorized Official
Title or Position : SENIOR DIRECTOR OF CLINICAL SERVICE
Name : LYNETTA HALE
Credential : AMFT, LPT, MA
Telephone Number : 626-332-3145
Provider Enumeration Date : 10/12/2005
Last Update Date : 03/01/2024

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