Organization
EXECUTIVE RECOVERY GROUP, INC
Active
Parent organization
EXECUTIVE RECOVERY GROUP, INC
Other names
Sanctuary Amgio, Renewal Health Group
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
4755 AMIGO AVE, TARZANA, CA 91356-4501
(760) 409-1287
Mailing address
203 S ORANGE DR, LOS ANGELES, CA 90036-3010
(760) 409-1287
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
190042BP
DEPARTMENT OF HEALTH CARE SERVICES
CA
Enumeration date
05/17/2019
Last updated
02/10/2022
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