Provider Demographics
NPI:1689156507
Name:LEAD RECOVERY TRANSITIONAL LIVING CENTER, LLC
Entity Type:Organization
Organization Name:LEAD RECOVERY TRANSITIONAL LIVING CENTER, LLC
Other - Org Name:LEAD RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:NURMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-282-9447
Mailing Address - Street 1:1516 BROOKHOLLOW DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5401
Mailing Address - Country:US
Mailing Address - Phone:949-282-9447
Mailing Address - Fax:
Practice Address - Street 1:1516 BROOKHOLLOW DR UNIT A
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5401
Practice Address - Country:US
Practice Address - Phone:949-282-9447
Practice Address - Fax:949-666-8393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit