Organization
EXECUTIVE RECOVERY GROUP, INC
Active
Parent organization
EXECUTIVE RECOVERY GROUP, INC
Other names
The Lake IOP
Organization subpart
Yes
Provider details
NPI number
Legal business name
EXECUTIVE RECOVERY GROUP, INC
Authorized official
AMY CRICHTON (EXECUTIVE DIRECTOR)
(760) 200-3839
Entity
Organization
Contact information
Practice address
15613 VENTURA BLVD, ENCINO, CA 91436-3128
(760) 409-1287
Mailing address
35450 PEGASUS CT, PALM DESERT, CA 92211-1604
(760) 409-1287
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
190042CP
DEPARTMENT OF HEALTH CARE SERVICES
CA
Enumeration date
07/25/2019
Last updated
07/25/2019
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