| Executive Recovery Group, Inc | |
|
15613 Ventura Blvd Encino CA 91436-3128 | |
| (760) 409-1287 | |
| Not Available |
| Full Name | Executive Recovery Group, Inc |
|---|---|
| Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
| Location | 15613 Ventura Blvd, Encino, California |
| Authorized Official Name and Position | Amy Crichton (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7602003839 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Executive Recovery Group, Inc 35450 Pegasus Ct Palm Desert CA 92211-1604 Ph: (760) 409-1287 | Executive Recovery Group, Inc 15613 Ventura Blvd Encino CA 91436-3128 Ph: (760) 409-1287 |
| NPI Number | 1922652296 |
|---|---|
| Provider Enumeration Date | 07/25/2019 |
| Last Update Date | 07/25/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922652296 | NPI | - | NPPES |
| 190042CP | Other | CA | DEPARTMENT OF HEALTH CARE SERVICES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | (* (Not Available)) | Primary |
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