MEDICARE: KAMI RECOVERY

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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1962099176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAMI RECOVERY

Provider Business Mailing Address
First Line	:	PO BOX 1868
Second Line	:
City	:	CLAREMONT
State	:	CA
Zip	:	91711-8868
Country	:	US
Telephone Number	:	626-798-2727
Fax Number	:	626-798-2777

Provider Business Practice Location Address
First Line	:	1084 NEW YORK DR
Second Line	:
City	:	ALTADENA
State	:	CA
Zip	:	91001-3118
Country	:	US
Telephone Number	:	626-798-2727
Fax Number	:	626-798-2777

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. NORMA MENDIOLA
Credential	:
Telephone Number	:	626-798-2727

Provider Enumeration Date	:	12/22/2020
Last Update Date	:	12/22/2020

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Directions to “KAMI RECOVERY ” Practice Location

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