EXECUTIVE RECOVERY GROUP, INC (NPI# 1972169605) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972169605 |
| Entity Type | Organization |
| Organization Name | EXECUTIVE RECOVERY GROUP, INC |
| Practice Address |
4755 Amigo Ave Tarzana CA 91356-4501 |
| Mailing Address |
35450 Pegasus Ct Palm Desert CA 92211-1604 |
| Practice Telephone | 7604091287 |
| Mailing Telephone | 7604091287 |
| Enumeration Date | 2019-05-17 |
| Last Update Date | 2019-05-17 |
| Authorized Official Name | AMY CRICHTON (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 7602003839 |
| Is Organization Subpart | Y |
| Parent Organization Name | EXECUTIVE RECOVERY GROUP, INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities | ||
| Y | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | DEPARTMENT OF HEALTH CARE SERVICES | 190042BP | 01 |
| Other Name | Type Code |
|---|---|
| Renewal Health Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871108928 | Executive Recovery Group, Inc | Clinic/Center | 77725 Enfield Ln Ste 200, Palm Desert, CA 92211-0468 | 2020-09-14 |
| 1922652296 | Executive Recovery Group, Inc | Clinic/Center | 15613 Ventura Blvd, Encino, CA 91436-3128 | 2019-07-25 |
| 1942702055 | Executive Recovery Group, Inc | Clinic/Center | 77725 Enfield Ln # 100-200, Palm Desert, CA 92211 | 2018-03-05 |
| 1033580113 | Executive Recovery Group, Inc | Substance Abuse Rehabilitation Facility | 35450 Pegasus Ct, Palm Desert, CA 92211 | 2015-10-14 |
| Street Address |
4755 AMIGO AVE |
| City | TARZANA |
| State | CA |
| Zip Code | 91356-4501 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679137293 | Sarah Badreau | Behavior Technician | 5554 Reseda Blv., Tarzana, CA 91356 | 2019-04-29 |
| 1831661966 | Daraie Dental Group Inc | Dentist | 5620 Wilbur Avenue Ste 300, Tarzana, CA 91356 | 2018-12-31 |
| 1982182770 | Blanca Garay | Respiratory Therapist, Registered | 18214 Burbank Blvd Apt 120, Tarzana, CA 91356 | 2018-08-02 |
| 1437659000 | Chloe Kang | Speech-Language Pathologist | 19019 Ventura Blvd., Tarzana, CA 91356 | 2018-02-20 |
| 1114430139 | Avb & Lv Corporation | Home Health | 18340 Ventura Blvd Ste 220, Tarzana, CA 91356 | 2017-11-13 |
| 1881110468 | Samina Qadir | Registered Nurse | 18321 Clark St., Tarzana, CA 91356 | 2017-08-16 |
| 1700306776 | Debbie Rehman Lux | Marriage & Family Therapist | 18370 Burbank Blvd., Suite 211, Tarzana, CA 91356 | 2017-06-21 |
| 1467980631 | Valley Nerological Services, LLC | Radiology | 5260 Wilbur Ave Ste 207, Tarzana, CA 91356 | 2017-05-31 |
| 1669906020 | Evolve Growth Initiatives LLC | Clinic/Center | 5435 Aura Avenue, Tarzana, CA 91356 | 2017-04-12 |
| 1780130088 | Evolve Growth Initiatives, LLC | Clinic/Center | 5358 Vanalden Drive, Tarzana, CA 91356 | 2016-08-28 |
| Find all providers in zip 91356 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| 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. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922623040 | West Valley Detox Treatment | Substance Abuse Rehabilitation Facility | 18841 Pasadero Dr, Tarzana, CA 91356-5224 | 2020-06-15 |
| 1124666334 | Avedis Detox Inc. | Substance Abuse Rehabilitation Facility | 4945 Lindley Ave, Tarzana, CA 91356-4319 | 2019-12-18 |
| 1750929923 | West Health Inc. | Substance Abuse Rehabilitation Facility | 4725 Vanalden Ave, Tarzana, CA 91356-5036 | 2019-12-18 |
| 1770126849 | Vogue Recovery California, LLC | Substance Abuse Rehabilitation Facility | 4960 Vanalden Ave, Tarzana, CA 91356-4718 | 2019-10-22 |
| 1275002743 | 7 Star Recovery LLC | Substance Abuse Rehabilitation Facility | 4709 Caritina Dr, Tarzana, CA 91356-5010 | 2018-11-14 |
| 1629552542 | Nautilus Recovery Group, Inc | Substance Abuse Rehabilitation Facility | 5803 Corbin Ave, Tarzana, CA 91356-1004 | 2018-09-17 |
| 1356846786 | Real Estate Holiday Rentals Booking Worldwide, LLC | Substance Abuse Rehabilitation Facility | 6040 Calvin Ave, Tarzana, CA 91356-1115 | 2018-03-27 |
| 1124572706 | Peace By Piece Treatment Center Inc | Substance Abuse Rehabilitation Facility | 5343 Shirley Ave, Tarzana, CA 91356-2908 | 2016-08-11 |
| 1902237209 | Active Recovery Center, Inc. | Substance Abuse Rehabilitation Facility | 6316 Etiwanda Ave, Tarzana, CA 91335-7032 | 2013-12-12 |
| 1104443779 | Cmj Recovery Ca LLC | Substance Abuse Rehabilitation Facility | 4960 Vanalden Ave, Tarzana, CA 91356-4718 | 2020-06-30 |
| Find all providers in TARZANA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.