Refuge Recovery House

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

190853BP Issued in CA

Legal business name

REFUGE RECOVERY HOUSE

Practice address

1007 Manzanita St
Los Angeles, CA 90029-3011

Phone

(323) 787-7077

NPI assigned

Nov 13, 2015

Organization subpart

No

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

Authorized official

Name

Shannon Fowler

Title

Program Director/Cofounder

Phone

(323) 787-7077

Specialties & licenses 1

Addresses

Other names 1

• Refuge Recovery Centers Doing business as

Tax ID family

Refuge Recovery Centers2 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.

• Refuge Recovery House, LLC

  • Substance Abuse Rehabilitation Facility
  • Los Angeles, CA
  • NPI 1205238508
  NPD tax ID

Locations

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

{
    "created_epoch": "1447372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447372800000",
    "number": "1902270960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4302 MELROSE AVE STE 5C",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900293511",
            "telephone_number": "323-787-7077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 MANZANITA ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900293011",
            "telephone_number": "323-787-7077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REFUGE RECOVERY HOUSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-13",
        "last_updated": "2015-11-13",
        "status": "A",
        "authorized_official_last_name": "FOWLER",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR/COFOUNDER",
        "authorized_official_telephone_number": "323-787-7077"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "190853BP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Refuge Recovery Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ryan P. Reformina, NP-C
• Sina Refoua
• Tannaz Refoua, DDS
• Refuah Recovery Medical Group
• Refuge Recovery Clinical Services
• Refuge Recovery House, LLC
• Gayla Vanoush Rega
• Concepcion A Regacho, M.D.
• Regain Life, Inc.
• Regal Medical Supplies Inc

• Substance Abuse Rehabilitation Facility in Los Angeles, CA
• Providers in Los Angeles, 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 Nov 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.