NPIMap

Organization Active NPI

Executive Recovery Group, Inc

  • Substance Abuse Rehabilitation Facility
  • Tarzana, CA
National Provider Identifier
1972169605
Registry record updated Feb 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
EXECUTIVE RECOVERY GROUP, INC
Doing business as
Renewal Health Group
Sanctuary Amgio
Practice address
4755 Amigo Ave
Tarzana, CA 91356-4501
Phone
(760) 409-1287
NPI assigned
May 17, 2019
Organization subpart
Yes
Parent organization
EXECUTIVE RECOVERY GROUP, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 10, 2022

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
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

4755 Amigo Ave
Tarzana, CA 91356-4501

Mailing address

203 S Orange Dr
Los Angeles, CA 90036-3010
Phone (760) 409-1287

Other identifiers 1

IdentifierTypeStateIssuer
190042BPOtherCADEPARTMENT OF HEALTH CARE SERVICES

Other names 2

  • Renewal Health Group Doing business as
  • Sanctuary Amgio Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2169060Executive Recovery Group, LLC Dba Oasis Behavioral4755 Amigo Blvd, Tarzana, CA 91356Certificate of waiverJul 14, 2027

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.

NPI Registry JSON

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

{
    "created_epoch": "1558051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644451200000",
    "number": "1972169605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 S ORANGE DR",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900363010",
            "telephone_number": "760-409-1287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4755 AMIGO AVE",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913564501",
            "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": "2019-05-17",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "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": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF HEALTH CARE SERVICES",
            "identifier": "190042BP",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Renewal Health Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sanctuary Amgio",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tarzana, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2022; 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.