Healthcare Provider Details

I. General information

NPI: 1801787676
Provider Name (Legal Business Name): RAW RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31961 CALLE REYNALDA
SAN JUAN CAPISTRANO CA
92675-3166
US

IV. Provider business mailing address

31961 CALLE REYNALDA
SAN JUAN CAPISTRANO CA
92675-3166
US

V. Phone/Fax

Practice location:
  • Phone: 949-503-3037
  • Fax:
Mailing address:
  • Phone: 949-503-3037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN MINARDI
Title or Position: CEO
Credential:
Phone: 469-321-0193