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General NPI Number Information
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NPI Number | 1215488002
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Entity Type | Organization
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Legal Business Name | CORRAL MANAGEMENT, LLC
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Dates
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Enumeration Date | 10/17/2016
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Last Update Date | 10/26/2017
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Provider Practice Location Address
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Address Line | 26041 RED CORRAL RD
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-6310
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Country | US
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Telephone | 949-929-1177
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Fax |
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Provider Business Mailing Address
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Address Line | 26041 RED CORRAL RD
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-6310
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Country | US
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Telephone | 949-929-1177
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MS. KIM SIMMONS
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Credential | MA, CADCCS, CAT IV
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Telephone | 949-929-1177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State | CA
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