NPIMap

Organization Active NPI

Executive Recovery Group, Inc

Doing business as The Lake IOP

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Encino, CA
National Provider Identifier
1922652296
Registry record updated Jul 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
EXECUTIVE RECOVERY GROUP, INC
Doing business as
The Lake IOP
Practice address
15613 Ventura Blvd
Encino, CA 91436-3128
Phone
(760) 409-1287
NPI assigned
Jul 25, 2019
Last updated
Jul 25, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
EXECUTIVE RECOVERY GROUP, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 25, 2019

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

Authorized official

Name
Amy Crichton
Title
Executive Director
Phone
(760) 200-3839

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X NU
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X NU Primary

Addresses

Primary practice location

15613 Ventura Blvd
Encino, CA 91436-3128

Mailing address

35450 Pegasus CT
Palm Desert, CA 92211-1604
Phone (760) 409-1287

Other identifiers 1

IdentifierTypeStateIssuer
190042CPOtherCADEPARTMENT OF HEALTH CARE SERVICES

Other names 1

  • The Lake IOP Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Executive Recovery Group Inc9 organizations share this tax ID, including this one
Part of
Executive Recovery Group Inc

Other organizations with this tax ID 8

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

Locations

77725 Enfield Ln
Ste 200
Palm Desert, CA 92211

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1564012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564012800000",
    "number": "1922652296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35450 PEGASUS CT",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922111604",
            "telephone_number": "760-409-1287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15613 VENTURA BLVD",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914363128",
            "telephone_number": "760-409-1287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE RECOVERY GROUP, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EXECUTIVE RECOVERY GROUP, INC",
        "enumeration_date": "2019-07-25",
        "last_updated": "2019-07-25",
        "status": "A",
        "authorized_official_last_name": "CRICHTON",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "760-200-3839"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF HEALTH CARE SERVICES",
            "identifier": "190042CP",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Lake IOP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Encino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2019; 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.