Healthcare Provider Details

I. General information

NPI: 1821918558
Provider Name (Legal Business Name): DOUBLE R RANCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

19292 EL TORO RD
SILVERADO CA
92676-9710
US

IV. Provider business mailing address

1 HOPE DR
TUSTIN CA
92782-0221
US

V. Phone/Fax

Practice location:
  • Phone: 714-441-8058
  • Fax:
Mailing address:
  • Phone: 714-247-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: BRYAN CRAIN
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 714-247-4351