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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
1251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1821126939
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 : 23701 E EAST FORK RD
Second Line :
City : AZUSA
State : CA
Zip : 91702-1477
Country : US
Telephone Number : 626-250-3291
Fax Number : 626-910-1380
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 : 03/01/2007
Last Update Date : 03/01/2024

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