Provider Demographics
NPI:1972236172
Name:QUALITY CARE RECOVERY
Entity Type:Organization
Organization Name:QUALITY CARE RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TAVACKUS
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:RADT
Authorized Official - Phone:213-924-5275
Mailing Address - Street 1:6258 S LA BREA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90056-1913
Mailing Address - Country:US
Mailing Address - Phone:213-924-5275
Mailing Address - Fax:
Practice Address - Street 1:9100 S SEPULVEDA BLVD STE 220
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-4850
Practice Address - Country:US
Practice Address - Phone:213-924-5275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit