MEDICARE: INNER-TRIBAL TREATMENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
2	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1609555887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER-TRIBAL TREATMENT

Provider Business Mailing Address
First Line	:	PO BOX 823
Second Line	:
City	:	PAUMA VALLEY
State	:	CA
Zip	:	92061-0823
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16160 HIGHWAY 76 UNIT 401
Second Line	:
City	:	PAUMA VALLEY
State	:	CA
Zip	:	92061-2017
Country	:	US
Telephone Number	:	949-356-1944
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	ANTHONY FERRIGNO
Credential	:
Telephone Number	:	949-356-1944

Provider Enumeration Date	:	07/14/2023
Last Update Date	:	06/26/2024

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Directions to “INNER-TRIBAL TREATMENT ” Practice Location

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