Provider Demographics
NPI:1679815252
Name:PACIFIC BAY RECOVERY INC
Entity Type:Organization
Organization Name:PACIFIC BAY RECOVERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:DUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:619-461-3717
Mailing Address - Street 1:13967 CAMPO RD STE 202A
Mailing Address - Street 2:
Mailing Address - City:JAMUL
Mailing Address - State:CA
Mailing Address - Zip Code:91935-3232
Mailing Address - Country:US
Mailing Address - Phone:619-461-3717
Mailing Address - Fax:619-303-1379
Practice Address - Street 1:13967 CAMPO RD STE 202B
Practice Address - Street 2:
Practice Address - City:JAMUL
Practice Address - State:CA
Practice Address - Zip Code:91935-3232
Practice Address - Country:US
Practice Address - Phone:619-461-3717
Practice Address - Fax:619-330-1379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-21
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA370136APOtherDHCS CERTIFICATION