MEDICARE: PROJECT RECOVERY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	324500000X	Substance Abuse Rehabilitation Facility
2	101Y00000X	Counselor
3	101YA0400X	Addiction (Substance Use Disorder) Counselor
4	207QA0401X	Addiction Medicine (Family Medicine) Physician
5	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1821796103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROJECT RECOVERY LLC

Provider Business Mailing Address
First Line	:	2411 FENTON ST STE 103
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91914-3517
Country	:	US
Telephone Number	:	760-581-4357
Fax Number	:

Provider Business Practice Location Address
First Line	:	9760 BIRCH CANYON PL
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-1076
Country	:	US
Telephone Number	:	760-581-4357
Fax Number	:

Authorized Official
Title or Position	:	CCO
Name	:	CHARLES JACKSON
Credential	:
Telephone Number	:	480-787-1591

Provider Enumeration Date	:	02/16/2023
Last Update Date	:	09/03/2024

Similar Medicare Providers

1801520481 — SOPHIA C COUCH APCC
Practice Location Address:

5920 FRIARS RD
SAN DIEGO, CA
92108-1076

Practice Phone: 619-728-4177
Practice Fax:

1841160108 — FRANCESCO CARRILLO
Practice Location Address:

5920 FRIARS RD
SAN DIEGO, CA
92108-1076

Practice Phone: 619-684-5700
Practice Fax:

1790648475 — TAYLOR GOOD
Practice Location Address:

4231 BALBOA AVE # 1076
SAN DIEGO, CA
92117-5504

Practice Phone: 909-263-2400
Practice Fax:

1902765381 — SHARON MITCHELL
Practice Location Address:

110 SAN JACINTO ST
HUNTSVILLE, TX
77320-1076

Practice Phone: 936-581-8088
Practice Fax:

1720777634 — MR. LEE JACKSON
Practice Location Address:

1076 HOWARD ST , SECOND FL
SAN FRANCISCO, CA
94103-2820

Practice Phone: 628-217-7854
Practice Fax: 415-217-7868

1427012103 — PROF. ADA NIVIA RIVERA PT
Practice Location Address:

1076 CALLE 17 , VILLA NEVAREZ
SAN JUAN, PR
00927-5326

Practice Phone: 787-720-8882
Practice Fax: 787-720-8882

Directions to “PROJECT RECOVERY LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.