Provider Demographics
NPI:1639663230
Name:PACIFICA RECOVERY INC
Entity Type:Organization
Organization Name:PACIFICA RECOVERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YOGESH
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-318-0626
Mailing Address - Street 1:280 E MEL AVE
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4817
Mailing Address - Country:US
Mailing Address - Phone:760-318-0626
Mailing Address - Fax:760-318-0610
Practice Address - Street 1:280 E MEL AVE
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4817
Practice Address - Country:US
Practice Address - Phone:769-318-0626
Practice Address - Fax:760-318-0610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-18
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 251S00000X, 261QM0850X, 276400000X, 324500000X
CA330027AP324500000X
CA330027BP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit