Organization
LIVING PROOF RECOVERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GERALD M POOL LAADC, CADCII, S.A.P (OWNER/DIRECTOR OF OPERATIONS)
(626) 205-2518
Entity
Organization
Contact information
Practice address
324 W FOOTHILL BLVD, MONROVIA, CA 91016-2149
(626) 205-2518
(626) 446-5910
Mailing address
PO BOX 2420, MONROVIA, CA 91017-6420
(626) 205-2518
(626) 446-5910
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
190316BP
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
190316BP
DEPARTMENT OF ALCOHOL AND DRUG PROGRAMS
CA
Enumeration date
02/09/2009
Last updated
05/17/2013
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