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General NPI Number Information
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NPI Number | 1174219000
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Entity Type | Organization
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Legal Business Name | READY TO EVOLVE RECOVERY CENTER LLC
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Dates
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Enumeration Date | 04/13/2023
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 9320 BASE LINE RD STE A
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91701-5829
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Country | US
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Telephone | 909-746-7952
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Fax | 909-360-1332
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Provider Business Mailing Address
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Address Line | 9320 BASE LINE RD STE A
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91701-5829
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Country | US
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Telephone | 909-746-7952
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Fax | 909-360-1332
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | KELLINA SANDERS
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Credential |
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Telephone | 909-746-7952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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