Provider Demographics
NPI:1679906119
Name:TML RECOVERY, LLC
Entity type:Organization
Organization Name:TML RECOVERY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUTSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-419-4929
Mailing Address - Street 1:34249 CAMINO CAPISTRANO
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CAPISTRANO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92624
Mailing Address - Country:US
Mailing Address - Phone:949-419-4929
Mailing Address - Fax:
Practice Address - Street 1:34249 CAMINO CAPISTRANO
Practice Address - Street 2:
Practice Address - City:CAPISTRANO BEACH
Practice Address - State:CA
Practice Address - Zip Code:92624
Practice Address - Country:US
Practice Address - Phone:949-481-6156
Practice Address - Fax:949-542-3878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D2063707OtherCLIA