Organization
MLRC, INC.
Active
Other names
MyLife Recovery Centers IOP
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT ANDREW FUNKHOUSER CATC (INTERIM DIRECTOR)
(812) 204-4324
Entity
Organization
Contact information
Practice address
71777 SAN JACINTO DR STE 102B, RANCHO MIRAGE, CA 92270-4457
(812) 204-4324
Mailing address
71777 SAN JACINTO DR STE 102B, RANCHO MIRAGE, CA 92270-4457
(812) 204-4324
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
12/13/2016
Last updated
12/13/2016
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