Provider Demographics
NPI:1891246716
Name:ALIVE RECOVERY, INC.
Entity Type:Organization
Organization Name:ALIVE RECOVERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF WELLNESS SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEJONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-234-4817
Mailing Address - Street 1:27636 YNEZ RD
Mailing Address - Street 2:L7-289
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24359 JACARTE DR
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-4011
Practice Address - Country:US
Practice Address - Phone:951-234-4817
Practice Address - Fax:951-848-0949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management