Provider Demographics
NPI:1447388434
Name:SOCIAL MODEL RECOVERY SYSTEMS, INC.
Entity Type:Organization
Organization Name:SOCIAL MODEL RECOVERY SYSTEMS, INC.
Other - Org Name:PASADENA COUNCIL ON ALCOHOLISM AND DRUG DEPENDENCE
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 1:1245 E WALNUT ST
Practice Address - Street 2:SUITE 101,103,107,109,115,117,118
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1878
Practice Address - Country:US
Practice Address - Phone:626-795-9127
Practice Address - Fax:626-795-0979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01735308Medicaid