Provider Demographics
NPI:1356890073
Name:MORNINGSIDE RECOVERY, LLC
Entity type:Organization
Organization Name:MORNINGSIDE RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:G
Authorized Official - Last Name:YATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-675-0006
Mailing Address - Street 1:1400 REYNOLDS AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5559
Mailing Address - Country:US
Mailing Address - Phone:949-675-0006
Mailing Address - Fax:949-675-0007
Practice Address - Street 1:9842 13TH ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-3171
Practice Address - Country:US
Practice Address - Phone:949-675-0006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility