Healthcare Provider Details

I. General information

NPI: 1831908276
Provider Name (Legal Business Name): RUSTLERS REAL ESTATE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18023 SKY PARK CIR STE F
IRVINE CA
92614-6550
US

IV. Provider business mailing address

20500 BELSHAW AVE. DPT#XLA1130
CARSON CA
90746
US

V. Phone/Fax

Practice location:
  • Phone: 714-352-9138
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AARON BAILEY
Title or Position: VP OF CORPORATE DEVELOPMENT & GENER
Credential:
Phone: 714-352-9138