Provider Demographics
NPI:1497486526
Name:MOUNTAIN SKY RECOVERY, LLC
Entity Type:Organization
Organization Name:MOUNTAIN SKY RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLYLE
Authorized Official - Suffix:
Authorized Official - Credentials:CADC-CS, ICCS, CCDS
Authorized Official - Phone:949-228-8478
Mailing Address - Street 1:39785 SPINNING WHEEL DR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-4734
Mailing Address - Country:US
Mailing Address - Phone:949-228-8478
Mailing Address - Fax:
Practice Address - Street 1:39785 SPINNING WHEEL DR
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-4734
Practice Address - Country:US
Practice Address - Phone:949-228-8478
Practice Address - Fax:951-602-8090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility