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General NPI Number Information
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NPI Number | 1528683166
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Entity Type | Organization
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Legal Business Name | MIDAS RECOVERY LLC
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Dates
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Enumeration Date | 06/09/2020
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Last Update Date | 06/09/2020
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Provider Practice Location Address
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Address Line | 252 LAUREN CT
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City | LAKE ELSINORE
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State | CA
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Zip | 92530-5137
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Country | US
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Telephone | 951-457-2473
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Fax |
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Provider Business Mailing Address
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Address Line | 25060 HANCOCK AVE STE 103-182
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City | MURRIETA
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State | CA
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Zip | 92562-5930
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TREVOR FOREHAND
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Credential |
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Telephone | 951-457-1488
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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 |
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