Provider Demographics
NPI:1053900100
Name:RECOVER ADDICTION SERVICES INC.
Entity type:Organization
Organization Name:RECOVER ADDICTION SERVICES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GULINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-208-0121
Mailing Address - Street 1:1155 CAMINO DEL MAR STE 465
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2605
Mailing Address - Country:US
Mailing Address - Phone:760-815-8546
Mailing Address - Fax:
Practice Address - Street 1:1155 CAMINO DEL MAR STE 465
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2605
Practice Address - Country:US
Practice Address - Phone:760-815-8546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-13
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty