Provider Demographics
NPI:1184013781
Name:DR RECOVERY ENCINITAS LLC
Entity type:Organization
Organization Name:DR RECOVERY ENCINITAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:NATE
Authorized Official - Middle Name:
Authorized Official - Last Name:IZZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-419-4929
Mailing Address - Street 1:609 S VULCAN AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3600
Mailing Address - Country:US
Mailing Address - Phone:949-419-4929
Mailing Address - Fax:949-542-3878
Practice Address - Street 1:609 S. VULCAN AVE STE 301
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024
Practice Address - Country:US
Practice Address - Phone:949-419-4929
Practice Address - Fax:949-484-7021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA370143AP261QR0405X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D2083893OtherCLIA
CA370143APOtherDEPARTMENT OF HEALTHCARE SERVICES DHHS
CA05D2083893OtherCLIA