Provider Demographics
NPI:1518458298
Name:PACIFIC BAY RECOVERY INC
Entity Type:Organization
Organization Name:PACIFIC BAY RECOVERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-592-8695
Mailing Address - Street 1:1501 5TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-3224
Mailing Address - Country:US
Mailing Address - Phone:619-493-0436
Mailing Address - Fax:
Practice Address - Street 1:4959 CRESITA DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-2339
Practice Address - Country:US
Practice Address - Phone:619-493-0436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility