Executive Residential Care & Recovery LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

EXECUTIVE RESIDENTIAL CARE & RECOVERY LLC

Doing business as

SYNERGY ESTATE

Practice address

70806 Halper Lake Dr
Rancho Mirage, CA 92270-2523

Phone

(760) 832-8810

NPI assigned

Aug 26, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tammy Mora

Title

Assoc. Director of Patient Acct

Phone

(562) 576-1284

Specialties & licenses 1

Addresses

Other names 1

• SYNERGY ESTATE Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1661472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661472000000",
    "number": "1063131407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11627 TELEGRAPH RD STE 200",
            "city": "SANTA FE SPRINGS",
            "state": "CA",
            "postal_code": "906706814",
            "telephone_number": "562-576-1284",
            "fax_number": "562-861-0883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70806 HALPER LAKE DR",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922702523",
            "telephone_number": "760-832-8810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE RESIDENTIAL CARE & RECOVERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-26",
        "last_updated": "2022-08-26",
        "certification_date": "2022-08-26",
        "status": "A",
        "authorized_official_last_name": "MORA",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "ASSOC. DIRECTOR OF PATIENT ACCT",
        "authorized_official_telephone_number": "562-576-1284"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SYNERGY ESTATE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Leo Estrada Jr., MD
• April Susan Ethridge, P.A.
• Bayani V. Evangelista, M.D.
• Evans Optometry Clinic Inc.
• Gregory E Evans, O.D.
• Eye Surgery Center of the Desert
• Aubrey Glenn Eyer, M.D.
• Faculty Medical Group of Llusm
• Faculty Physicians and Surgeons of Llusm
• Faculty Physicians and Surgeons of Llusm

• Mental Illness Community Based Residential Treatment Facility in Rancho Mirage, CA
• Providers in Rancho Mirage, CA by specialty
• Mental Illness Community Based Residential Treatment Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.