MEDICARE: CLEAR RECOVERY CENTER, LLC

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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	190863IP	OTHER	CA	DHCS

General Provider Information

NPI Number	:	1972175065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEAR RECOVERY CENTER, LLC

Provider Business Mailing Address
First Line	:	18119 PRAIRIE AVE
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90504-3739
Country	:	US
Telephone Number	:	877-799-1985
Fax Number	:	866-899-1638

Provider Business Practice Location Address
First Line	:	515 N SEPULVEDA BLVD STE B
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-6748
Country	:	US
Telephone Number	:	877-799-1985
Fax Number	:	866-899-1638

Authorized Official
Title or Position	:	CMO
Name	:	DR. MARTHA KOO
Credential	:	MD
Telephone Number	:	877-799-1985

Provider Enumeration Date	:	07/16/2021
Last Update Date	:	10/23/2025

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Directions to “CLEAR RECOVERY CENTER, LLC ” Practice Location

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