1487055380 NPI number — APEX RECOVERY, LLC

Table of content: (NPI 1487055380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487055380 NPI number — APEX RECOVERY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APEX RECOVERY, LLC
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:
1487055380
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2810 CAMINO DEL RIO S STE 106
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92108-3819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-756-6424
Provider Business Mailing Address Fax Number:
619-713-6071

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4251 NABAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91941-7167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-756-6424
Provider Business Practice Location Address Fax Number:
619-713-6071
Provider Enumeration Date:
09/10/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BRUHIN
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
JACOB
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
619-756-6424

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  370138AP , 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: 370138AP . This is a "CALIFORNIA DEPARTMENT OF HEALTH CARE PROVIDERS RESIDENTIAL LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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