NPIMap

Organization Active NPI

Pain Recovery Medical Group, Inc

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Dana Point, CA
National Provider Identifier
1841683984
Registry record updated Mar 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
PAIN RECOVERY MEDICAL GROUP, INC
Doing business as
Headrick Integrative Healing
Practice address
34085 Pacific Coast Hwy
#203
Dana Point, CA 92629-2764
Phone
(714) 377-3749
Fax
(714) 377-5642
NPI assigned
Mar 13, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2015

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

Authorized official

Name
Renee Fuller
Title
Business Manager
Phone
(562) 308-0461

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

34085 Pacific Coast Hwy
#203
Dana Point, CA 92629-2764

Mailing address

PO Box 6747
Huntington Beach, CA 92615-6747
Phone (714) 377-3749

Other names 1

  • Headrick Integrative Healing Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Headrick Integrative Healing2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

34085 Pacific Coast Hwy
Ste 203
Dana Point, CA 92629
Phone (714) 377-3749

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1426204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426204800000",
    "number": "1841683984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6747",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926156747",
            "telephone_number": "714-377-3749",
            "fax_number": "714-377-5642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34085 PACIFIC COAST HWY",
            "address_2": "#203",
            "city": "DANA POINT",
            "state": "CA",
            "postal_code": "926292764",
            "telephone_number": "714-377-3749",
            "fax_number": "714-377-5642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN RECOVERY MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-13",
        "last_updated": "2015-03-13",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "RENEE",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "562-308-0461"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Headrick Integrative Healing",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dana Point, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2015; 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.