Local 92109 LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

LOCAL 92109 LLC

Doing business as

Boardwalk Recovery Center

Practice address

1940 Garnet Ave Ste 120
San Diego, CA 92109

Phone

(619) 206-0081

NPI assigned

Jan 23, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Amanda Tamai

Title

Executive Assistant

Phone

(619) 206-0081

Specialties & licenses 1

Addresses

Other names 1

• Boardwalk Recovery Center Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1516665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534291200000",
    "number": "1639677768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1940 GARNET AVE STE 120",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921093575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1940 GARNET AVE STE 120",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92109",
            "telephone_number": "619-206-0081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOCAL 92109 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-23",
        "last_updated": "2018-08-15",
        "status": "A",
        "authorized_official_last_name": "TAMAI",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "EXECUTIVE ASSISTANT",
        "authorized_official_telephone_number": "619-206-0081",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boardwalk Recovery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Boardwalk Recovery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Aljon Ona Loberia
• Alissia Lobo
• Alvin Joseph Lobo, RPH
• Sarah Lobo
• Loc Bao, DDS, Inc.
• Brian J Locascio, MT-BC
• Christopher Laurence Locascio, PSY.D.
• Madeline Jennings Lock
• Corrine Locke
• Jenay Olivia Locke

• Substance Use Disorder Rehabilitation Clinic/Center in San Diego, CA
• Providers in San Diego, CA by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.