Provider Demographics
NPI:1902110158
Name:EMBRACE RECOVERY
Entity Type:Organization
Organization Name:EMBRACE RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:OFFERDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-525-3696
Mailing Address - Street 1:23232 PERALTA DR
Mailing Address - Street 2:SUITE 219
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1443
Mailing Address - Country:US
Mailing Address - Phone:949-525-3696
Mailing Address - Fax:949-448-9710
Practice Address - Street 1:23232 PERALTA DR
Practice Address - Street 2:SUITE 219
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1443
Practice Address - Country:US
Practice Address - Phone:949-525-3696
Practice Address - Fax:949-448-9710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-29
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA970117101YA0400X
CA261QR0405X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder