1083757041 NPI number — ABLE TO CHANGE RECOVERY, INC.

Table of content: (NPI 1083757041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083757041 NPI number — ABLE TO CHANGE RECOVERY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABLE TO CHANGE RECOVERY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083757041
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31501 RANCHO VIEJO RD
Provider Second Line Business Mailing Address:
#101
Provider Business Mailing Address City Name:
SAN JUAN CAPISTRANO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92675-1869
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-493-6800
Provider Business Mailing Address Fax Number:
949-493-6832

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31501 RANCHO VIEJO RD
Provider Second Line Business Practice Location Address:
#101
Provider Business Practice Location Address City Name:
SAN JUAN CAPISTRANO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92675-1869
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-493-6800
Provider Business Practice Location Address Fax Number:
949-493-6832
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PASTOR
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
O
Authorized Official Title or Position:
BILLING
Authorized Official Telephone Number:
949-493-6800

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  300118BP , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 300118CP , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 300118AP , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 005692 . This is a "BLUE CROSS MED ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 005693 . This is a "BLUE CROSS MED ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 300118CP . This is a "CA DEPT ALCOHOL DRUG PROGRAMS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 300118BP . This is a "CA DEPT ALCOHOL DRUG PROGRAMS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 005494 . This is a "BLUE CROSS MED ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 300118AP . This is a "CA DEPT ALCOHOL DRUG PROGRAMS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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