Provider Demographics
NPI:1538459060
Name:RANCH CREEK RECOVERY,INC.
Entity Type:Organization
Organization Name:RANCH CREEK RECOVERY,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TICHELAAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-695-9300
Mailing Address - Street 1:27636 YNEZ RD # 271
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5600
Mailing Address - Country:US
Mailing Address - Phone:951-676-9111
Mailing Address - Fax:951-695-2509
Practice Address - Street 1:25650 BASS PT
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9424
Practice Address - Country:US
Practice Address - Phone:951-696-9200
Practice Address - Fax:951-695-2509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-18
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA330100AP324500000X
324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
1538459060OtherNPI NUMBER