Provider Demographics
NPI:1306285820
Name:ALT RECOVERY GROUP LLC
Entity type:Organization
Organization Name:ALT RECOVERY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-503-3898
Mailing Address - Street 1:1141 MALL DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8194
Mailing Address - Country:US
Mailing Address - Phone:575-522-0660
Mailing Address - Fax:575-522-3151
Practice Address - Street 1:1141 MALL DR
Practice Address - Street 2:SUITE E
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8194
Practice Address - Country:US
Practice Address - Phone:575-522-0660
Practice Address - Fax:575-522-3151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207QA0401X
NMNM10059M261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM42738229Medicaid