1447388434 NPI number — SOCIAL MODEL RECOVERY SYSTEMS, INC.

Table of content: (NPI 1447388434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447388434 NPI number — SOCIAL MODEL RECOVERY SYSTEMS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOCIAL MODEL RECOVERY SYSTEMS, 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:
6
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:
1447388434
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
223 E ROWLAND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COVINA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91723-3147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-332-3145
Provider Business Mailing Address Fax Number:
626-974-4164

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44 S MENTOR AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91106-2902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-795-9127
Provider Business Practice Location Address Fax Number:
626-795-0979
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HALE
Authorized Official First Name:
LYNETTA
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR DIRECTOR OF CLINICAL SERVICE
Authorized Official Telephone Number:
626-332-3145

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01735308 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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