Provider Demographics
NPI:1881845337
Name:ATLANTIC RECOVERY SERVICES
Entity Type:Organization
Organization Name:ATLANTIC RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-436-3533
Mailing Address - Street 1:944 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-4228
Mailing Address - Country:US
Mailing Address - Phone:562-436-3533
Mailing Address - Fax:
Practice Address - Street 1:1020 E PALMDALE BLVD
Practice Address - Street 2:#101C
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4756
Practice Address - Country:US
Practice Address - Phone:562-436-3533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7006Medicaid