EXECUTIVE RECOVERY GROUP, INC (NPI# 1922652296) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922652296 |
| Entity Type | Organization |
| Organization Name | EXECUTIVE RECOVERY GROUP, INC |
| Practice Address |
15613 Ventura Blvd Encino CA 91436-3128 |
| Mailing Address |
35450 Pegasus Ct Palm Desert CA 92211-1604 |
| Practice Telephone | 7604091287 |
| Mailing Telephone | 7604091287 |
| Enumeration Date | 2019-07-25 |
| Last Update Date | 2019-07-25 |
| 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 | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
Ambulatory Health Care Facilities | ||
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | DEPARTMENT OF HEALTH CARE SERVICES | 190042CP | 01 |
| Other Name | Type Code |
|---|---|
| The Lake IOP | 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 |
| 1972169605 | Executive Recovery Group, Inc | Clinic/Center | 4755 Amigo Ave, Tarzana, CA 91356-4501 | 2019-05-17 |
| 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 |
15613 VENTURA BLVD |
| City | ENCINO |
| State | CA |
| Zip Code | 91436-3128 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801405014 | Find Your Balance, Center for Growth & Change Inc. | Marriage & Family Therapist | 15720 Ventura Blvd Suite 603, Encino, CA 91436 | 2020-07-24 |
| 1396214482 | Maria Guadalupe Cruz | Behavior Technician | 16500 Ventura Blvd # 414, Encino, CA 91436 | 2018-11-19 |
| 1699277186 | Rodolfo Alavez Jimenez | Behavior Technician | 16500 Ventura Blvd., Suite 414, Encino, CA 91436 | 2018-03-01 |
| 1750891503 | Robert James Kim-farley | Preventive Medicine | 4037 Rogen Drive, Encino, CA 91436 | 2017-10-06 |
| 1528577871 | Julia Szpakiewicz | Marriage & Family Therapist | 16550 Ventura Blvd 318, Encino, CA 91436 | 2017-09-28 |
| 1457875452 | Jeffrey Proniloff | Dentist | 16680 Ashley Oaks, Encino, CA 91436 | 2017-08-01 |
| 1114449592 | Loren Lizeth Huerta | Specialist/Technologist | 16500 Ventura Blvd #414, Encino, CA 91436 | 2017-07-07 |
| 1538619838 | Gilbert Torres Jr. | Physical Therapist | 16260 Ventura Blvd # 600, Encino Medical Tower, Encino, CA 91436 | 2016-10-11 |
| 1417313529 | Nancy L Reynolds | Marriage & Family Therapist | 16055 Ventura Blvd #409, Encino, CA 91436 | 2016-01-05 |
| 1457716748 | Salvador Salgado | Behavioral Analyst | 16500 Ventura Blvd. Suite 414, Encino, CA 91436 | 2015-12-31 |
| Find all providers in zip 91436 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043831548 | Phase Two Atc LLC | Clinic/Center | 15720 Ventura Blvd Ste Ph, Encino, CA 91436-2914 | 2020-05-06 |
| 1720432800 | Canyon West Los Angeles LLC | Clinic/Center | 17167 W. Ventura Boulevard, Encino, CA 91316 | 2016-04-14 |
| 1205011582 | Tfsc-encino | Clinic/Center | 16260 Ventura Blvd Ste 309, Encino, CA 91436-2276 | 2008-01-04 |
| 1134557705 | Inner Actions, LLC | Clinic/Center | 17609 Ventura Blvd Ste 215, Encino, CA 91316-5126 | 2013-10-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609476845 | Vanity Wellness Center Incorporated | Clinic/Center | 19935 Ventura Blvd Fl 1, Woodland Hills, CA 91364-9605 | 2020-10-27 |
| 1184230328 | Recovery & Resilience Centers | Clinic/Center | 1665 Creekside Dr Ste 100, Folsom, CA 95630-3538 | 2020-09-22 |
| 1518573526 | A Ka Center, LLC | Clinic/Center | 4715 Divine Way, La Mesa, CA 91941-6832 | 2020-09-16 |
| 1821602186 | New Bridge Foundation, Inc. | Clinic/Center | 1777 Leroy Avenue, Berkeley, CA 94709-1156 | 2020-09-03 |
| 1942814793 | Ola Wellness Retreat, LLC | Clinic/Center | 26926 Pacific Coast Hwy, Malibu, CA 90265-4358 | 2020-08-31 |
| 1336752963 | Ola Wellness Retreat, LLC | Clinic/Center | 26924 Pacific Coast Hwy, Malibu, CA 90265-4356 | 2020-08-24 |
| 1003427337 | Restorative Partners, Inc. | Clinic/Center | 3220 S Higuera St Ste 103a, San Luis Obispo, CA 93401-2023 | 2020-08-11 |
| 1255941597 | Pathways Recovery | Clinic/Center | 4904 Hollycrest Way, Fair Oaks, CA 95628-5114 | 2020-08-02 |
| 1104435734 | New Life Health Authority / Dba New Life LLC | Clinic/Center | 280 E Standley St, Ukiah, CA 95482-4414 | 2020-07-29 |
| 1043829971 | House of Hope Foundation Inc | Clinic/Center | 227 W 9th St, San Pedro, CA 90731-3711 | 2020-07-27 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on EXECUTIVE RECOVERY GROUP, INC.
| 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.