Provider Demographics
NPI:1417432071
Name:PACIFIC RECOVERY SOLUTIONS
Entity Type:Organization
Organization Name:PACIFIC RECOVERY SOLUTIONS
Other - Org Name:3235 HILLOCK DRIVE
Other - Org Type:Other Name
Authorized Official - Title/Position:CBO
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ATHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-804-7684
Mailing Address - Street 1:7966 BEVERLY BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4511
Mailing Address - Country:US
Mailing Address - Phone:918-804-7684
Mailing Address - Fax:
Practice Address - Street 1:3235 HILLOCK DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-1427
Practice Address - Country:US
Practice Address - Phone:323-745-0074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELYSIAN HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-30
Last Update Date:2019-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility