EXECUTIVE RECOVERY GROUP INC NPI 1972169605

NPI Information

NPI: 1972169605
Provider Name: EXECUTIVE RECOVERY GROUP, INC

Doing Business As: RENEWAL HEALTH GROUP

Classification: Substance Abuse Rehabilitation Facility - 324500000X
Entity Type: Organization

Address:
4755 AMIGO AVE
TARZANA, CA
ZIP 91356
Phone: (760) 409-1287
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EXECUTIVE RECOVERY GROUP, INC is a substance abuse rehabilitation facility in Tarzana, CA. The provider is a facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. EXECUTIVE RECOVERY GROUP, INC NPI is 1972169605. The provider is registered as an organization entity type.
The provider Is Doing Business As Renewal Health Group.

The provider's business location address is:

4755 AMIGO AVE
TARZANA, CA
ZIP 91356-501
Phone: (760) 409-1287

The provider's authorized official is Amy Crichton .
The authorized official title is Executive Director and has the following contact phone number (760) 200-3839.

The CLIA number assigned to this NPI record is 05D2169060 - other - behavioral health rehab with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/17/2019 and was last updated on 2/10/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)			No
2	324500000X	Substance Abuse Rehabilitation Facility				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	190042BP	OTHER	CALIFORNIA	DEPARTMENT OF HEALTH CARE SERVICES

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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