Provider Demographics
NPI:1750829016
Name:ANCHORED TIDES RECOVERY
Entity Type:Organization
Organization Name:ANCHORED TIDES RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-377-7706
Mailing Address - Street 1:19126 MAGNOLIA ST
Mailing Address - Street 2:STE 101
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-2235
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19126 MAGNOLIA ST
Practice Address - Street 2:STE 101
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-2235
Practice Address - Country:US
Practice Address - Phone:714-377-7706
Practice Address - Fax:949-791-2137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility