Organization
SO CAL RECOVERY CENTERS DP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LINDSEY MYERS (CEO)
(949) 481-6156
Entity
Organization
Contact information
Practice address
44267 MONTEREY AVE STE A&B, PALM DESERT, CA 92260-2755
(949) 481-6156
(949) 542-3878
Mailing address
34249 CAMINO CAPISTRANO STE 101, CAPISTRANO BEACH, CA 92624-1156
(949) 481-6156
(949) 542-3878
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
291U00000X
Clinical Medical Laboratory
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D2152160
CLIA
—
01
—
330018AP
STATE OF CALIFORNIA
CA
Enumeration date
08/06/2019
Last updated
12/04/2019
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