Provider Demographics
NPI:1689294472
Name:ACTIVE RECOVERY SOLUTIONS LLC
Entity Type:Organization
Organization Name:ACTIVE RECOVERY SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCREERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-858-3786
Mailing Address - Street 1:5318 ALLOTT AVE
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-5903
Mailing Address - Country:US
Mailing Address - Phone:213-858-3786
Mailing Address - Fax:
Practice Address - Street 1:5316 LUBAO AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-3623
Practice Address - Country:US
Practice Address - Phone:213-858-3786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA190892APOtherCOMMERCIAL INSURANCES