Provider Demographics
NPI:1265210249
Name:SIMPLE PATH RECOVERY LLC
Entity type:Organization
Organization Name:SIMPLE PATH RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHEYENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN-PILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-302-1010
Mailing Address - Street 1:55 E HUNTINGTON DR STE 108
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3246
Mailing Address - Country:US
Mailing Address - Phone:949-302-1010
Mailing Address - Fax:
Practice Address - Street 1:68 RIO RANCHO RD
Practice Address - Street 2:UNIT 201-202
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766
Practice Address - Country:US
Practice Address - Phone:949-302-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder