Healthcare Provider Details

I. General information

NPI: 1053724716
Provider Name (Legal Business Name): 10 ACRE RANCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18002 IRVINE BLVD
TUSTIN CA
92780-3301
US

IV. Provider business mailing address

18002 IRVINE BLVD
TUSTIN CA
92780-3301
US

V. Phone/Fax

Practice location:
  • Phone: 866-274-9892
  • Fax:
Mailing address:
  • Phone: 866-274-9892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. ISMAIL JADALLAH
Title or Position: ADMINISTRATOR
Credential:
Phone: 949-381-9159