Organization
NAUTILUS RECOVERY GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON VAUGHN SHOEMAKER PHD (CEO)
(310) 795-4066
Entity
Organization
Contact information
Practice address
5803 CORBIN AVE, TARZANA, CA 91356-1004
(734) 751-4956
Mailing address
8033 W SUNSET BLVD # 946, WEST HOLLYWOOD, CA 90046-2401
(310) 795-4066
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
816290448
CCAPPP
CA
Enumeration date
09/17/2018
Last updated
09/06/2023
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