Pacific Manor Recovery LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

PACIFIC MANOR RECOVERY LLC

Practice address

3686 Pacific Ave
Riverside, CA 92509-1948

Phone

(888) 700-5053

Fax

(949) 209-5490

NPI assigned

Jul 31, 2020

Organization subpart

No

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

Authorized official

Name

Tanisha Porreca

Title

Assistant to Ceo

Phone

(828) 773-4477

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1596153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630281600000",
    "number": "1639789035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3151 AIRWAY AVE STE E1",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926264620",
            "telephone_number": "888-700-5053",
            "fax_number": "949-209-5490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3686 PACIFIC AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925091948",
            "telephone_number": "888-700-5053",
            "fax_number": "949-209-5490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC MANOR RECOVERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-31",
        "last_updated": "2021-08-30",
        "certification_date": "2021-08-30",
        "status": "A",
        "authorized_official_last_name": "PORRECA",
        "authorized_official_first_name": "TANISHA",
        "authorized_official_title_or_position": "ASSISTANT TO CEO",
        "authorized_official_telephone_number": "828-773-4477"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fabiola Pacheco, LCSW
• Maria Celeste Pacheco
• Rita Pacheco
• Pacific Family Medical Inc
• Pacific Grove Hospital
• Pacific Professional Surgical Group Inc
• Pacific Pulmonary Care
• Pacifica Health & Wellness Clinic, Inc.
• Pacifica Riverside SL LP (Cottages at Riverside)
• Justin William Packham, MA, AMFT, APCC

• Substance Abuse Rehabilitation Facility in Riverside, CA
• Providers in Riverside, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.