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General NPI Number Information
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NPI Number | 1427385277
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Entity Type | Organization
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Legal Business Name | MIRACLE RECOVERY CENTER, LLC
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Dates
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Enumeration Date | 11/14/2009
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Last Update Date | 11/14/2009
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Provider Practice Location Address
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Address Line | 3342 VENADO ST
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City | CARLSBAD
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State | CA
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Zip | 92009-7849
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Country | US
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Telephone | 866-538-8153
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Fax | 760-814-8161
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Provider Business Mailing Address
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Address Line | 7668 EL CAMINO REAL #104-704
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City | CARLSBAD
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State | CA
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Zip | 92009-7932
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Country | US
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Telephone | 866-538-8153
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Fax | 760-814-8161
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Authorized Official
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Title or Position | DIRECTOR/CO-FOUNDER
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Name | MRS. ALI JONES
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Credential |
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Telephone | 760-450-4604
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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 | 370124AP
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License Number State | CA
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