1851112221 NPI number — REVIVING YOU RECOVERY HOUSE LLC

Table of content: MS. CANDRA LYNN SNYDER ANP (NPI 1033212485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851112221 NPI number — REVIVING YOU RECOVERY HOUSE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REVIVING YOU RECOVERY HOUSE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851112221
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
304 N STAGE COACH LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FALLBROOK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92028-2420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-420-3261
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28889 PARK TRAIL WAY
Provider Second Line Business Practice Location Address:
MENIFEE
Provider Business Practice Location Address City Name:
MENIFEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-420-3261
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/18/2024

Additional Information

Authorized Official

Authorized Official Last Name:
MORRIS
Authorized Official First Name:
NIKKI
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
760-420-3261

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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