Provider Demographics
NPI:1558812412
Name:SIMPLE RECOVERY, INC.
Entity Type:Organization
Organization Name:SIMPLE RECOVERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CCO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ODOM
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:949-646-3600
Mailing Address - Street 1:1901 NEWPORT BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2278
Mailing Address - Country:US
Mailing Address - Phone:949-646-3600
Mailing Address - Fax:
Practice Address - Street 1:20621 PAISLEY LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-6014
Practice Address - Country:US
Practice Address - Phone:949-646-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300247DP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility