Provider Demographics
NPI:1023550431
Name:PACIFIC CITY RECOVERY
Entity Type:Organization
Organization Name:PACIFIC CITY RECOVERY
Other - Org Name:PACIFIC CITY RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VOURNAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-413-3339
Mailing Address - Street 1:11851 WISTERIA AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2654
Mailing Address - Country:US
Mailing Address - Phone:949-642-4150
Mailing Address - Fax:949-642-3441
Practice Address - Street 1:11851 WISTERIA AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-2654
Practice Address - Country:US
Practice Address - Phone:949-642-4150
Practice Address - Fax:949-642-3441
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COASTAL RECOVERY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-16
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility