Provider Demographics
NPI:1619195476
Name:ATLANTIC RECOVERY SERVICES
Entity Type:Organization
Organization Name:ATLANTIC RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-436-3533
Mailing Address - Street 1:944 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-4228
Mailing Address - Country:US
Mailing Address - Phone:562-436-3533
Mailing Address - Fax:562-435-6379
Practice Address - Street 1:2100 W CLEVELAND AVE
Practice Address - Street 2:MONTEBELLO HIGH SCHOOL MUSD
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4032
Practice Address - Country:US
Practice Address - Phone:323-728-0121
Practice Address - Fax:323-887-2113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190229AN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7146Medicaid