Provider Demographics
NPI:1659863108
Name:EXECUTIVE RECOVERY GROUP, INC
Entity Type:Organization
Organization Name:EXECUTIVE RECOVERY GROUP, INC
Other - Org Name:SANCTUARY TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRICHTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-200-3839
Mailing Address - Street 1:19233 WHITE STONE CT
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1131
Mailing Address - Country:US
Mailing Address - Phone:760-409-1287
Mailing Address - Fax:
Practice Address - Street 1:19233 WHITE STONE CT
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1131
Practice Address - Country:US
Practice Address - Phone:760-409-1287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXECUTIVE RECOVERY GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-31
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No251S00000XAgenciesCommunity/Behavioral Health