Healthcare Provider Details

I. General information

NPI: 1538654520
Provider Name (Legal Business Name): RANCHO MILAGRO RECOVERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37235 PAINTED PONY RD
TEMECULA CA
92592-8221
US

IV. Provider business mailing address

37115 PAINTED PONY RD
TEMECULA CA
92592-8262
US

V. Phone/Fax

Practice location:
  • Phone: 951-852-7674
  • Fax:
Mailing address:
  • Phone: 951-526-3227
  • Fax:

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: JUDEE RAFFAEL TOMPKINS
Title or Position: CFO
Credential:
Phone: 951-526-3227