Organization
PEPPERMINT RIDGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN A GARRETT M.S.W. (EXECUTIVE DIRECTOR)
(951) 273-7320
Entity
Organization
Contact information
Practice address
4045 CASTLE PINES WAY, CORONA, CA 92883-0603
(951) 273-7347
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
—
LTC60836F
VILLA VADNAIS
CA
Enumeration date
05/03/2007
Last updated
08/22/2020
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