Provider Demographics
NPI:1154479517
Name:PACIFICA RECOVERY, INC.
Entity Type:Organization
Organization Name:PACIFICA RECOVERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SERVICES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANTONIOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-413-1318
Mailing Address - Street 1:3717 E THOUSAND OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3607
Mailing Address - Country:US
Mailing Address - Phone:805-413-1318
Mailing Address - Fax:805-413-1304
Practice Address - Street 1:415 W FOOTHILL BLVD
Practice Address - Street 2:STE 210
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-2766
Practice Address - Country:US
Practice Address - Phone:626-813-3771
Practice Address - Fax:626-813-3772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health