Provider Demographics
NPI:1780021071
Name:PACIFIC VIEW RECOVERY CENTER
Entity type:Organization
Organization Name:PACIFIC VIEW RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DEKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:760-641-3972
Mailing Address - Street 1:643 PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2437
Mailing Address - Country:US
Mailing Address - Phone:310-392-2320
Mailing Address - Fax:
Practice Address - Street 1:643 PACIFIC ST
Practice Address - Street 2:UNIT 1
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-2437
Practice Address - Country:US
Practice Address - Phone:310-392-2320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility