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Organization

T & D RECOVERY SERVICES, INC.

Active
Other names
OC Revive Wellness
Organization subpart
No

Provider details

NPI number
Authorized official
TYLER MICHAELIS (CEO)
(949) 606-4681
Entity
Organization

Contact information

Practice address
24432 MUIRLANDS BLVD STE 223, LAKE FOREST, CA 92630-3951
(949) 606-4681
Mailing address
24432 MUIRLANDS BLVD STE 223, LAKE FOREST, CA 92630-3951

Taxonomy

Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center

Other

Enumeration date
10/30/2018
Last updated
10/30/2018
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