Organization
PACIFIC MANOR RECOVERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANISHA PORRECA (ASSISTANT TO CEO)
(828) 773-4477
Entity
Organization
Contact information
Practice address
3686 PACIFIC AVE, RIVERSIDE, CA 92509-1948
(888) 700-5053
(949) 209-5490
Mailing address
3151 AIRWAY AVE STE E1, COSTA MESA, CA 92626-4620
(888) 700-5053
(949) 209-5490
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
07/31/2020
Last updated
08/30/2021
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