Provider Demographics
NPI:1730630070
Name:PRODUCTS FOR RECOVERY MANAGEMENT GROUP LLC
Entity type:Organization
Organization Name:PRODUCTS FOR RECOVERY MANAGEMENT GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-835-0123
Mailing Address - Street 1:PO BOX 16727
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92623-6727
Mailing Address - Country:US
Mailing Address - Phone:305-733-5928
Mailing Address - Fax:888-965-9813
Practice Address - Street 1:33151 MESA VISTA DR
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-1112
Practice Address - Country:US
Practice Address - Phone:770-374-9970
Practice Address - Fax:949-799-2543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility