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NPI Code Detail

MEDICARE: BII AJ OUR HOUSE, LLC

MEDICARE: BII AJ OUR HOUSE, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1324500000XSubstance Abuse Rehabilitation Facility

General Provider Information

NPI Number : 1720417892
Entity Type Code : Organization
Provider Name (Legal Business Name) : BII AJ OUR HOUSE, LLC
Provider Business Mailing Address
First Line : 43500 RIDGE PARK DR
Second Line : SUITE 101
City : TEMECULA
State : CA
Zip : 92590-3624
Country : US
Telephone Number : 951-294-5870
Fax Number : 951-294-5806
Provider Business Practice Location Address
First Line : 1119 W 7TH ST
Second Line :
City : SAN JACINTO
State : CA
Zip : 92582-3856
Country : US
Telephone Number : 951-294-5870
Fax Number : 951-294-5806
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MS. ARLEAN JEAN TRUAX
Credential :
Telephone Number : 951-294-5870
Provider Enumeration Date : 11/08/2013
Last Update Date : 11/08/2013

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Directions to “BII AJ OUR HOUSE, LLC ” Practice Location

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