Provider Demographics
NPI:1013395565
Name:REFUGE TREATMENT CENTER INC.
Entity Type:Organization
Organization Name:REFUGE TREATMENT CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:LOREN
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-337-4224
Mailing Address - Street 1:PO BOX 1238
Mailing Address - Street 2:
Mailing Address - City:LAKE ARROWHEAD
Mailing Address - State:CA
Mailing Address - Zip Code:92352-1238
Mailing Address - Country:US
Mailing Address - Phone:909-337-4224
Mailing Address - Fax:909-336-7357
Practice Address - Street 1:1366 YELLOWSTONE DR.
Practice Address - Street 2:
Practice Address - City:LAKE ARROWHEAD
Practice Address - State:CA
Practice Address - Zip Code:92352-1238
Practice Address - Country:US
Practice Address - Phone:909-337-4224
Practice Address - Fax:909-336-7357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty