Provider Demographics
NPI:1871266940
Name:RANCHO MILAGRO RECOVERY INC
Entity Type:Organization
Organization Name:RANCHO MILAGRO RECOVERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JUDEE
Authorized Official - Middle Name:RAFFAEL
Authorized Official - Last Name:TOMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-526-3227
Mailing Address - Street 1:37235 PAINTED PONY RD
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-8221
Mailing Address - Country:US
Mailing Address - Phone:951-526-3227
Mailing Address - Fax:
Practice Address - Street 1:27570 COMMERCE CENTER DR STE 220-222
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2501
Practice Address - Country:US
Practice Address - Phone:951-526-3227
Practice Address - Fax:951-602-7999
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RANCHO MILAGRO RECOVERY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility