EXECUTIVE RECOVERY GROUP, INC (NPI# 1942702055) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942702055 |
| Entity Type | Organization |
| Organization Name | EXECUTIVE RECOVERY GROUP, INC |
| Other Organization Name | PHOENIX RISING RECOVERY |
| Practice Address |
77725 Enfield Ln # 100-200 Palm Desert CA 92211 |
| Mailing Address |
77725 Enfield Ln Palm Desert CA 92211-0468 |
| Practice Telephone | 7603457239 |
| Mailing Telephone | 7604091287 |
| Enumeration Date | 2018-03-05 |
| Last Update Date | 2018-08-07 |
| 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 | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
330143BP | CA | Ambulatory Health Care Facilities |
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
330143BP | CA | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Phoenix Rising Recovery | Doing Business As Name - Organization |
| Phoenix Rising Recovery IOP | Doing Business As Name - Organization |
| The Lake | Other Name - Individual/Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 17801 Twilight Ln, Encino, CA 913164330 | 7604091287 | |
| 35450 Pegasus Ct, Palm Desert, CA 922111604 | 7604091287 |
| 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 |
| 1972169605 | Executive Recovery Group, Inc | Clinic/Center | 4755 Amigo Ave, Tarzana, CA 91356-4501 | 2019-05-17 |
| 1033580113 | Executive Recovery Group, Inc | Substance Abuse Rehabilitation Facility | 35450 Pegasus Ct, Palm Desert, CA 92211 | 2015-10-14 |
| Street Address |
77725 ENFIELD LN # 100-200 |
| City | PALM DESERT |
| State | CA |
| Zip Code | 92211 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780293936 | Childnet Youth and Family Services, Inc. | Community/Behavioral Health | 42-600 Cook Street, Suite 100, Palm Desert, CA 92211 | 2020-07-23 |
| 1003457607 | Catherine Krumplitsch | Technician | 41430 Kansas Street, Palm Desert, CA 92211 | 2019-10-04 |
| 1992248918 | West Coast Surgery Inc | Orthopaedic Surgery | 36915 Cook Street, Suite 103 B, Palm Desert, CA 92211 | 2016-11-22 |
| 1063963098 | Therese Tudor | Physical Therapist | 77-682 Country Club Drive, Suite G, Palm Desert, CA 92211 | 2016-10-14 |
| 1609249663 | John D Rasmussen | Anesthesiology | 160 Running Spring Drive, Palm Desert, CA 92211 | 2015-11-12 |
| 1033580113 | Executive Recovery Group, Inc | Substance Abuse Rehabilitation Facility | 35450 Pegasus Ct, Palm Desert, CA 92211 | 2015-10-14 |
| 1861862146 | Artur Sarkisyan | Dentist | 34-460 Monterey Ave Ste 100, Palm Desert, CA 92211 | 2015-09-30 |
| 1649686833 | Annamaria Valenzuela | Licensed Vocational Nurse | 77-777 Country Club Drive, Apt 235, Palm Desert, CA 92211 | 2014-07-08 |
| 1265876759 | Guardian Angel Home Care, Inc. | Home Health | 41865 Boardwalk, Suite 215, Palm Desert, CA 92211 | 2013-04-26 |
| 1831440502 | Aghaloo, Dds, Inc. | Dentist | 39620 Washington St. Suite C, Palm Desert, CA 92211 | 2012-09-21 |
| Find all providers in zip 92211 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
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|---|---|---|---|---|
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| 1366975344 | Sbr Recovery, LLC | Clinic/Center | 44775 Deep Canyon Rd, Palm Desert, CA 92260-3724 | 2017-04-06 |
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| City | PALM DESERT |
| Zip Code | 92211 |
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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.