Provider Demographics
NPI:1710355847
Name:PACIFIC CARE RECOVERY CENTER
Entity Type:Organization
Organization Name:PACIFIC CARE RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:THORIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAKOULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-481-7100
Mailing Address - Street 1:6920 VICTORIA AVE
Mailing Address - Street 2:#19
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-2971
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6920 VICTORIA AVE
Practice Address - Street 2:#19
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-2971
Practice Address - Country:US
Practice Address - Phone:562-481-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-06
Last Update Date:2015-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility