Provider Demographics
NPI:1376093237
Name:SOUTHERN CALIFORNIA SUNRISE RECOVERY CENTER
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA SUNRISE RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:USHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLAREAL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:949-533-4025
Mailing Address - Street 1:28562 OSO PKWY # D-313
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-5595
Mailing Address - Country:US
Mailing Address - Phone:949-533-3046
Mailing Address - Fax:
Practice Address - Street 1:30471 VIA ALCAZAR AVE
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2137
Practice Address - Country:US
Practice Address - Phone:949-388-3857
Practice Address - Fax:949-388-3857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility