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General NPI Number Information
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NPI Number | 1609765924
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Entity Type | Organization
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Legal Business Name | MENTAL HEALTH RESIDENTIAL INC
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Dates
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Enumeration Date | 07/01/2025
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 53295 OATES LANE
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City | IDYLLWILD
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State | CA
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Zip | 92549-4577
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Country | US
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Telephone | 800-750-2613
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Fax |
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Provider Business Mailing Address
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Address Line | 2224 GREENLEAF ST
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City | SANTA ANA
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State | CA
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Zip | 92706-2536
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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 | CONSULTANT
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Name | TYLER PENROD
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Credential |
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Telephone | 305-900-4715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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