Organization Name: | PAIN RECOVERY MEDICAL GROUP |
NPI Number: | 1528446044 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DANIEL HEADRICK (PRESIDENT) |
Mailing Address: | 243 Avenida La Cuesta San Clemente |
State: | CA US |
Postal Code: | 926722140 |
Phone Number: | 8449000444 |
Fax Number: | |
NPI Enumeration Date: | 05/16/2015 |
NPI Last Update Date: | 05/16/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 324500000X |
License Number: | G45144 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Substance Abuse Rehabilitation Facility |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |