Provider Demographics
NPI:1376923136
Name:PACE RECOVERY CENTER, LLC
Entity Type:Organization
Organization Name:PACE RECOVERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCO
Authorized Official - Prefix:
Authorized Official - First Name:SHAHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUZMEYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-924-6442
Mailing Address - Street 1:20051 SW BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1708
Mailing Address - Country:US
Mailing Address - Phone:520-390-5017
Mailing Address - Fax:949-490-4053
Practice Address - Street 1:414 11TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-4508
Practice Address - Country:US
Practice Address - Phone:949-640-0018
Practice Address - Fax:714-274-9517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-05
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300244DP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility