Provider Demographics
NPI:1700560695
Name:RANCHO RECOVERY LLC
Entity Type:Organization
Organization Name:RANCHO RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-292-6827
Mailing Address - Street 1:333 E ARROW HWY UNIT 220
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91785-7008
Mailing Address - Country:US
Mailing Address - Phone:909-476-2023
Mailing Address - Fax:909-697-2900
Practice Address - Street 1:13684 JEREMY CT
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-2031
Practice Address - Country:US
Practice Address - Phone:909-476-2023
Practice Address - Fax:909-697-2900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility