Provider Demographics
NPI:1871108928
Name:EXECUTIVE RECOVERY GROUP, INC
Entity type:Organization
Organization Name:EXECUTIVE RECOVERY GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UR AND BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUNIGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-702-4273
Mailing Address - Street 1:203 S ORANGE DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3010
Mailing Address - Country:US
Mailing Address - Phone:818-299-3602
Mailing Address - Fax:805-830-1565
Practice Address - Street 1:77725 ENFIELD LN STE 200
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-0468
Practice Address - Country:US
Practice Address - Phone:818-299-3602
Practice Address - Fax:805-830-1565
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXECUTIVE RECOVERY GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health