# PEPPERMINT RIDGE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295957728
- **Authorized official:** MR. JOHN A. GARRETT M.S.W. (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (951) 273-7320

## Contact information

- **Practice address:** 825 MAGNOLIA AVE, CORONA, CA 92804-3129
- **Practice address phone:** (951) 273-7320
- **Practice address fax:** (951) 737-0726
- **Mailing address:** 825 MAGNOLIA AVE, CORONA, CA 92804-3129
- **Mailing address phone:** (951) 273-7320
- **Mailing address fax:** (951) 737-0726

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | CA | Yes |

## Other

- **Enumeration date:** 05/03/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | LTC60227F | CONNER RESIDENCE | CA |