1154479517 NPI number — PACIFICA RECOVERY, INC.

Table of content: (NPI 1154479517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154479517 NPI number — PACIFICA RECOVERY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFICA 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:
1154479517
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3717 E THOUSAND OAKS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTLAKE VILLAGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91362-3607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-413-1318
Provider Business Mailing Address Fax Number:
805-413-1304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 W FOOTHILL BLVD
Provider Second Line Business Practice Location Address:
STE 210
Provider Business Practice Location Address City Name:
CLAREMONT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91711-2766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-813-3771
Provider Business Practice Location Address Fax Number:
626-813-3772
Provider Enumeration Date:
01/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ANTONIOU
Authorized Official First Name:
APRIL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CREDENTIALING SERVICES MANAGER
Authorized Official Telephone Number:
805-413-1318

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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