Organization
PEPPERMINT RIDGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN A. GARRETT M.S.W. (EXECUTIVE DIRECTOR)
95127327320
Entity
Organization
Contact information
Practice address
825 MAGNOLIA AVE, CORONA, CA 92879-3129
(951) 273-7320
(951) 737-0726
Mailing address
825 MAGNOLIA AVE, CORONA, CA 92879-3129
(951) 273-7320
(951) 737-0726
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LTC60027F
EVERGREEN ESTATES
CA
Enumeration date
05/07/2007
Last updated
08/22/2020
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