Provider Demographics
NPI:1508509373
Name:LIFEHOUSE RECOVERY, INC.
Entity Type:Organization
Organization Name:LIFEHOUSE RECOVERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ERICKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-489-1019
Mailing Address - Street 1:2985 E HILLCREST DR STE 203
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3192
Mailing Address - Country:US
Mailing Address - Phone:818-268-0989
Mailing Address - Fax:
Practice Address - Street 1:34711 CAPROCK RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91390-5423
Practice Address - Country:US
Practice Address - Phone:888-418-1019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-19
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility