Provider Demographics
NPI:1992159495
Name:LANDMARK RECOVERY, LLC
Entity type:Organization
Organization Name:LANDMARK RECOVERY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:REVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-792-9170
Mailing Address - Street 1:23265 S POINTE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1472
Mailing Address - Country:US
Mailing Address - Phone:888-792-9170
Mailing Address - Fax:888-972-2681
Practice Address - Street 1:23265 S POINTE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1472
Practice Address - Country:US
Practice Address - Phone:888-792-9170
Practice Address - Fax:888-972-2681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility