Provider Demographics
NPI:1083757041
Name:ABLE TO CHANGE RECOVERY, INC.
Entity Type:Organization
Organization Name:ABLE TO CHANGE RECOVERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:PASTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-493-6800
Mailing Address - Street 1:31501 RANCHO VIEJO RD
Mailing Address - Street 2:#101
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1869
Mailing Address - Country:US
Mailing Address - Phone:949-493-6800
Mailing Address - Fax:949-493-6832
Practice Address - Street 1:31501 RANCHO VIEJO RD
Practice Address - Street 2:#101
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1869
Practice Address - Country:US
Practice Address - Phone:949-493-6800
Practice Address - Fax:949-493-6832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300118BP324500000X
CA300118CP324500000X
CA300118AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA005692OtherBLUE CROSS MED ID
CA005693OtherBLUE CROSS MED ID
CA300118CPOtherCA DEPT ALCOHOL DRUG PROGRAMS
CA300118BPOtherCA DEPT ALCOHOL DRUG PROGRAMS
CA005494OtherBLUE CROSS MED ID
CA300118APOtherCA DEPT ALCOHOL DRUG PROGRAMS