Provider Demographics
NPI:1164907234
Name:IMPACT RECOVERY
Entity Type:Organization
Organization Name:IMPACT RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUELL
Authorized Official - Suffix:
Authorized Official - Credentials:CMRS
Authorized Official - Phone:949-842-2877
Mailing Address - Street 1:PO BOX 1449
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92693-1449
Mailing Address - Country:US
Mailing Address - Phone:949-842-2877
Mailing Address - Fax:949-248-2870
Practice Address - Street 1:28202 CABOT ROAD
Practice Address - Street 2:SUITE 331
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-1222
Practice Address - Country:US
Practice Address - Phone:714-398-5874
Practice Address - Fax:949-248-2870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-25
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251V00000XAgenciesVoluntary or Charitable
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility