NPIMap

Organization Active NPI

Peppermint Ridge

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Corona, CA
National Provider Identifier
1508075508
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
Legal business name
PEPPERMINT RIDGE
Practice address
1581 Heartland Way
Corona, CA 92881-4180
Phone
(951) 273-7346
Fax
(951) 737-0726
NPI assigned
May 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. John A. Garrett, M.S.W.
Title
Executive Director
Phone
(951) 273-7320

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X CA Primary

Addresses

Primary practice location

1581 Heartland Way
Corona, CA 92881-4180

Mailing address

825 Magnolia Ave
Corona, CA 92879-3129
Phone (951) 273-7320

Other identifiers 1

IdentifierTypeStateIssuer
LTC61074FOtherCAWYNN HOME

National Provider Directory

National Provider Directory
Tax ID family
Peppermint Ridge8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508075508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 MAGNOLIA AVE",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928793129",
            "telephone_number": "951-273-7320",
            "fax_number": "951-737-0726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1581 HEARTLAND WAY",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928814180",
            "telephone_number": "951-273-7346",
            "fax_number": "951-737-0726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEPPERMINT RIDGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GARRETT",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "951-273-7320",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.S.W."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WYNN HOME",
            "identifier": "LTC61074F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Corona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.