Provider Demographics
NPI:1164282463
Name:SIMPLE PATH RECOVERY LLC
Entity Type:Organization
Organization Name:SIMPLE PATH RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:NICOLAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-324-4875
Mailing Address - Street 1:55 E HUNTINGTON DR STE 108
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3246
Mailing Address - Country:US
Mailing Address - Phone:562-324-4875
Mailing Address - Fax:
Practice Address - Street 1:968 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-4142
Practice Address - Country:US
Practice Address - Phone:562-324-4875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility