Provider Demographics
NPI:1780198085
Name:ALT RECOVERY GROUP 2 LLC
Entity Type:Organization
Organization Name:ALT RECOVERY GROUP 2 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-993-5225
Mailing Address - Street 1:104 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-6520
Mailing Address - Country:US
Mailing Address - Phone:575-993-5225
Mailing Address - Fax:575-652-4163
Practice Address - Street 1:20946 DEVONSHIRE ST STE 100
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-8270
Practice Address - Country:US
Practice Address - Phone:575-993-5225
Practice Address - Fax:575-652-4163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-22
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone