Provider Demographics
NPI: | 1609141332 |
---|---|
Name: | MFI RECOVERY CENTER |
Entity Type: | Organization |
Organization Name: | MFI RECOVERY CENTER |
Other - Org Name: | MFI RANCHO VISTA HIGH SCHOOL |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CRAIG |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | LAMBDIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 951-683-6596 |
Mailing Address - Street 1: | 5870 ARLINGTON AVE |
Mailing Address - Street 2: | SUITE 103 |
Mailing Address - City: | RIVERSIDE |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92504-2037 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 951-683-6596 |
Mailing Address - Fax: | 951-683-4239 |
Practice Address - Street 1: | 32225 PIO PICO RD |
Practice Address - Street 2: | |
Practice Address - City: | TEMECULA |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92592-2772 |
Practice Address - Country: | US |
Practice Address - Phone: | 951-683-6596 |
Practice Address - Fax: | 951-683-4239 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-03-13 |
Last Update Date: | 2014-02-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 251S00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |