Healthcare Provider Details

I. General information

NPI: 1851914212
Provider Name (Legal Business Name): URP CALIFORNIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W 6TH ST
BEAUMONT CA
92223-2102
US

IV. Provider business mailing address

120 N FEDERAL HWY STE 206
LAKE WORTH FL
33460-3493
US

V. Phone/Fax

Practice location:
  • Phone: 954-654-9072
  • Fax: 954-251-3718
Mailing address:
  • Phone: 772-812-9652
  • Fax: 954-251-3718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: KAYLA MACDONALD
Title or Position: CEO
Credential:
Phone: 954-654-9072