Provider Demographics
NPI:1124496377
Name:SOUTHERN CALIFORNIA RECOVERY LLC
Entity type:Organization
Organization Name:SOUTHERN CALIFORNIA RECOVERY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCEFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-578-8600
Mailing Address - Street 1:5220 HOOD RD
Mailing Address - Street 2:#101
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-8910
Mailing Address - Country:US
Mailing Address - Phone:561-578-8600
Mailing Address - Fax:561-578-8601
Practice Address - Street 1:1771 SUMMITRIDGE DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-1607
Practice Address - Country:US
Practice Address - Phone:310-948-6446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19084AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility