Provider Demographics
NPI:1295004224
Name:SOCIAL MODEL RECOVERY SYSTEMS, INC.
Entity Type:Organization
Organization Name:SOCIAL MODEL RECOVERY SYSTEMS, INC.
Other - Org Name:RENA B. RECOVERY HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:SENIOR DIRECTOR OF CLINICAL SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:LYNETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:AMFT, LPT, MA
Authorized Official - Phone:626-332-3145
Mailing Address - Street 1:223 E ROWLAND ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3147
Mailing Address - Country:US
Mailing Address - Phone:626-332-3145
Mailing Address - Fax:626-974-4164
Practice Address - Street 1:4445,4439,4455 BURNS AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-2702
Practice Address - Country:US
Practice Address - Phone:323-664-8969
Practice Address - Fax:323-664-1786
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOCIAL MODEL RECOVERY SYSTEMS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-20
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190008FN324500000X
324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility