1154887768 NPI number — RECOVERY HEALTH GROUP, A PROFESSIONAL CORPORATION

Table of content: (NPI 1154887768)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154887768 NPI number — RECOVERY HEALTH GROUP, A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RECOVERY HEALTH GROUP, A PROFESSIONAL CORPORATION
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:
1154887768
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10880 WILSHIRE BLVD STE 1101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90024-4112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
424-256-8741
Provider Business Mailing Address Fax Number:
866-256-8741

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8605 SANTA MONICA BLVD PMB 28031
Provider Second Line Business Practice Location Address:
WEST HOLLYWOOD
Provider Business Practice Location Address City Name:
CA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90024-4112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-240-8511
Provider Business Practice Location Address Fax Number:
866-256-8741
Provider Enumeration Date:
02/19/2019

Additional Information

Authorized Official

Authorized Official Last Name:
MARTINEZ
Authorized Official First Name:
JEREMY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
424-256-8741

Provider Taxonomy Codes

  • Taxonomy code: 207RA0401X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0802X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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