Provider Demographics
NPI:1619372380
Name:MYLIFE RECOVERY CENTERS, A MEDICAL CORP.
Entity Type:Organization
Organization Name:MYLIFE RECOVERY CENTERS, A MEDICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-736-5836
Mailing Address - Street 1:10061 RIVERSIDE DR
Mailing Address - Street 2:#874
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2560
Mailing Address - Country:US
Mailing Address - Phone:818-736-5836
Mailing Address - Fax:818-736-5846
Practice Address - Street 1:108 LA CASA VIA
Practice Address - Street 2:SUITE 106
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3013
Practice Address - Country:US
Practice Address - Phone:925-201-6400
Practice Address - Fax:818-736-5846
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MYLIFE RECOVERY CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-23
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty