Provider Demographics
NPI:1932640596
Name:SOCIAL MODEL RECOVERY
Entity Type:Organization
Organization Name:SOCIAL MODEL RECOVERY
Other - Org Name:TOUCHSTONE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:NIGHT COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:VANNARY
Authorized Official - Middle Name:
Authorized Official - Last Name:NORITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-668-2171
Mailing Address - Street 1:1368 MOLINO AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-2383
Mailing Address - Country:US
Mailing Address - Phone:562-668-2171
Mailing Address - Fax:
Practice Address - Street 1:1368 MOLINO AVE APT 2
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2383
Practice Address - Country:US
Practice Address - Phone:562-668-2171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children