Provider Demographics
NPI:1881774073
Name:CHANGES FOR RECOVERY
Entity type:Organization
Organization Name:CHANGES FOR RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:
Authorized Official - Last Name:MUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:CADC II
Authorized Official - Phone:714-541-4007
Mailing Address - Street 1:300 N TUSTIN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3820
Mailing Address - Country:US
Mailing Address - Phone:714-541-4007
Mailing Address - Fax:714-541-2770
Practice Address - Street 1:300 N TUSTIN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3820
Practice Address - Country:US
Practice Address - Phone:714-541-4007
Practice Address - Fax:714-541-2770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300097BP101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty