Provider Demographics
NPI:1427418730
Name:RANCHO MILAGRO RECOVERY INC
Entity type:Organization
Organization Name:RANCHO MILAGRO RECOVERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDEE
Authorized Official - Middle Name:RAFFAEL
Authorized Official - Last Name:TOMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-526-3998
Mailing Address - Street 1:37115 PAINTED PONY RD
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-8262
Mailing Address - Country:US
Mailing Address - Phone:951-526-3998
Mailing Address - Fax:
Practice Address - Street 1:31985 HONEYSUCKLE CIR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:CA
Practice Address - Zip Code:92596-8730
Practice Address - Country:US
Practice Address - Phone:951-526-3998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA330144AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility