Provider Demographics
NPI:1669096624
Name:MELROSE GROUP LTD.
Entity type:Organization
Organization Name:MELROSE GROUP LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALT
Authorized Official - Middle Name:
Authorized Official - Last Name:YBARRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-970-0036
Mailing Address - Street 1:1247 N LAKEVIEW AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-1833
Mailing Address - Country:US
Mailing Address - Phone:714-970-0036
Mailing Address - Fax:
Practice Address - Street 1:1253 N COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-2003
Practice Address - Country:US
Practice Address - Phone:714-970-0036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility