MEDICARE: TUNNEL VISION RECOVERY 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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1982416715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TUNNEL VISION RECOVERY LLC

Provider Business Mailing Address
First Line	:	PO BOX 2100
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92628-2100
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6935 NE WATTS RD
Second Line	:
City	:	ELGIN
State	:	OK
Zip	:	73538-2337
Country	:	US
Telephone Number	:	405-353-2932
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SEAN FARRELL
Credential	:
Telephone Number	:	405-353-2932

Provider Enumeration Date	:	01/20/2025
Last Update Date	:	01/20/2025

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Directions to “TUNNEL VISION RECOVERY LLC ” Practice Location

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