Provider Demographics
NPI:1922602481
Name:CREST RECOVERY LLC
Entity Type:Organization
Organization Name:CREST RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CEAIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:COFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-233-0091
Mailing Address - Street 1:23726 BIRTCHER DR
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1771
Mailing Address - Country:US
Mailing Address - Phone:833-233-0091
Mailing Address - Fax:949-607-3118
Practice Address - Street 1:24861 SPADRA LN
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5226
Practice Address - Country:US
Practice Address - Phone:833-233-0091
Practice Address - Fax:949-607-3118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility