Healthcare Provider Details

I. General information

NPI: 1841944220
Provider Name (Legal Business Name): URP CA HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25402 HILLARY LN
LAGUNA HILLS CA
92653-5215
US

IV. Provider business mailing address

9050 PINES BLVD STE 460
PEMBROKE PINES FL
33024-6459
US

V. Phone/Fax

Practice location:
  • Phone: 954-654-9072
  • Fax: 954-251-3718
Mailing address:
  • Phone: 954-362-4389
  • Fax: 954-799-0234

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: COO
Credential:
Phone: 954-654-9072