Provider Demographics
NPI:1053884775
Name:MELROSE RECOVERY, LLC.
Entity type:Organization
Organization Name:MELROSE RECOVERY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WALT
Authorized Official - Middle Name:
Authorized Official - Last Name:YBARRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-970-0036
Mailing Address - Street 1:1247 N LAKEVIEW AVE, STE#B
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807
Mailing Address - Country:US
Mailing Address - Phone:714-970-0036
Mailing Address - Fax:714-970-1965
Practice Address - Street 1:1253 N COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029
Practice Address - Country:US
Practice Address - Phone:714-970-0036
Practice Address - Fax:714-970-1965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-04
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility