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General NPI Number Information
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NPI Number | 1013395565
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Entity Type | Organization
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Legal Business Name | REFUGE TREATMENT CENTER INC.
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Dates
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Enumeration Date | 05/15/2015
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Last Update Date | 05/15/2015
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Provider Practice Location Address
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Address Line | 1366 YELLOWSTONE DR.
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City | LAKE ARROWHEAD
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State | CA
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Zip | 92352-1238
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Country | US
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Telephone | 909-337-4224
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Fax | 909-336-7357
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Provider Business Mailing Address
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Address Line | PO BOX 1238
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City | LAKE ARROWHEAD
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State | CA
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Zip | 92352-1238
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Country | US
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Telephone | 909-337-4224
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Fax | 909-336-7357
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Authorized Official
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Title or Position | OWNER
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Name | NATHAN LOREN INGRAM
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Credential |
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Telephone | 909-337-4224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State | CA
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