Provider Demographics
NPI:1144606559
Name:PURE RECOVERY CALIFORNIA INC
Entity type:Organization
Organization Name:PURE RECOVERY CALIFORNIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:SILER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-815-3399
Mailing Address - Street 1:4300 TRADEWINDS DR STE 101
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-1460
Mailing Address - Country:US
Mailing Address - Phone:805-815-3399
Mailing Address - Fax:805-815-4499
Practice Address - Street 1:4300 TRADEWINDS DR STE 101
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93035-1460
Practice Address - Country:US
Practice Address - Phone:805-815-3399
Practice Address - Fax:805-815-4499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-07
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA560049AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility