Provider Demographics
NPI:1568024263
Name:INTEGRATED RECOVERY FOUNDATION 22
Entity Type:Organization
Organization Name:INTEGRATED RECOVERY FOUNDATION 22
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UR/BILLING
Authorized Official - Prefix:
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:B
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:951-813-1720
Mailing Address - Street 1:25 FLOR AMOR
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688
Mailing Address - Country:US
Mailing Address - Phone:951-813-1720
Mailing Address - Fax:949-484-7021
Practice Address - Street 1:30211 AVENIDA DE LAS BANDERA STE 200
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2159
Practice Address - Country:US
Practice Address - Phone:949-533-6075
Practice Address - Fax:949-484-7021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-02
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty