MLRC, Inc.

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

MLRC, INC.

Doing business as

MyLife Recovery Centers IOP

Practice address

108 La Casa Via
Walnut Creek, CA 94598-3013

Phone

(925) 201-6400

NPI assigned

Dec 12, 2016

Last updated

Dec 12, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Scott Andrew Funkhouser, CATC

Title

Interim Director

Phone

(812) 204-4324

Specialties & licenses 1

Addresses

Other names 1

• MyLife Recovery Centers IOP Doing business as

Tax ID family

MLRC Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• MLRC, Inc.

  dba MyLife Recovery Centers IOP

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Rancho Mirage, CA
  • NPI 1538603345
  NPD tax ID
• MLRC, Inc.

  dba MyLife Recovery Centers IOP

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Fresno, CA
  • NPI 1932643814
  NPD tax ID

Locations

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

{
    "created_epoch": "1481500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481500800000",
    "number": "1790229771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 LA CASA VIA",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945983013",
            "telephone_number": "925-201-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 LA CASA VIA",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945983013",
            "telephone_number": "925-201-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MLRC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-12",
        "last_updated": "2016-12-12",
        "status": "A",
        "authorized_official_last_name": "FUNKHOUSER",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "INTERIM DIRECTOR",
        "authorized_official_telephone_number": "812-204-4324",
        "authorized_official_credential": "CATC"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MyLife Recovery Centers IOP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Vikrant Mittal, MBBS, MD, MHS
• Robert Edward Mittendorff II, M.D.
• Lakeisha Diane Mixon
• Ryan Miyasaki
• Alicia Mizes
• Saina Moallempour
• Mobile Healthcare Integrations LLC
• Andrew Mobley, DPT
• Katie Mock, PHARMD
• Lawrence Glen Mock, OD

• Substance Use Disorder Rehabilitation Clinic/Center in Walnut Creek, CA
• Providers in Walnut Creek, CA by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2016; 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.