Provider Demographics
NPI:1790288116
Name:PMR IOP LLC
Entity Type:Organization
Organization Name:PMR IOP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GLADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:CADCII, ICADC
Authorized Official - Phone:951-662-5688
Mailing Address - Street 1:894 ANTILLA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-0917
Mailing Address - Country:US
Mailing Address - Phone:951-662-5688
Mailing Address - Fax:
Practice Address - Street 1:2945 HARDING ST STE 213
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1818
Practice Address - Country:US
Practice Address - Phone:951-662-5688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESENT MOMENTS RECOVERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-12
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder