Provider Demographics
NPI:1396221610
Name:SOUTHERN CALFIORNIA SUNRISE RECOVERY CENTER
Entity Type:Organization
Organization Name:SOUTHERN CALFIORNIA SUNRISE RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLARREAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-533-3046
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 1:25481 GLORIOSA DR
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-4641
Practice Address - Country:US
Practice Address - Phone:949-533-3046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility