Provider Demographics
NPI:1508589821
Name:MOM'S RETREAT RECUPERATIVE CARE & REFERRAL LLC
Entity Type:Organization
Organization Name:MOM'S RETREAT RECUPERATIVE CARE & REFERRAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-904-1668
Mailing Address - Street 1:1100 E ORANGETHORPE AVE STE 200L
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1144
Mailing Address - Country:US
Mailing Address - Phone:714-904-1668
Mailing Address - Fax:
Practice Address - Street 1:1100 E ORANGETHORPE AVE STE 200L
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1144
Practice Address - Country:US
Practice Address - Phone:714-904-1668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABUS2022-02010OtherBUSINESS LICENSE