Provider Demographics
NPI:1033450275
Name:ALPINE RECOVERY LODGE LLC
Entity Type:Organization
Organization Name:ALPINE RECOVERY LODGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHERMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-797-9977
Mailing Address - Street 1:1018 E OAKHILL DR
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:UT
Mailing Address - Zip Code:84004-1733
Mailing Address - Country:US
Mailing Address - Phone:626-797-9977
Mailing Address - Fax:626-844-2977
Practice Address - Street 1:1018 E OAKHILL DR
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:UT
Practice Address - Zip Code:84004-1733
Practice Address - Country:US
Practice Address - Phone:626-797-9977
Practice Address - Fax:626-844-2977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility