MLRC, INC. (NPI# 1790229771) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790229771 |
| Entity Type | Organization |
| Organization Name | MLRC, INC. |
| Other Organization Name | MYLIFE RECOVERY CENTERS IOP |
| Practice Address |
108 La Casa Via Walnut Creek CA 94598-3013 |
| Practice Telephone | 9252016400 |
| Mailing Telephone | 9252016400 |
| Enumeration Date | 2016-12-12 |
| Last Update Date | 2016-12-12 |
| Authorized Official Name | SCOTT ANDREW FUNKHOUSER (INTERIM DIRECTOR) |
| Authorized Official Telephone | 8122044324 |
| Authorized Official Credential | CATC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| MyLife Recovery Centers IOP | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538603345 | Mlrc, Inc. | Clinic/Center | 71777 San Jacinto Dr Ste 102b, Rancho Mirage, CA 92270-4457 | 2016-12-13 |
| 1932643814 | Mlrc, Inc. | Clinic/Center | 6073 N 1st St Ste 102, Fresno, CA 93710-5444 | 2016-12-12 |
| Street Address |
108 LA CASA VIA |
| City | WALNUT CREEK |
| State | CA |
| Zip Code | 94598-3013 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356364871 | Dennis Yunming Fong | Family Medicine | 108 La Casa Via, Suite 104, Walnut Creek, CA 94598 | 2006-07-25 |
| 1265971063 | Bay Area Surgical Specialists | Internal Medicine | 108 La Casa Via, Suite 100, Walnut Creek, CA 94598-3013 | 2017-02-14 |
| 1629510201 | Kwon & Jabbour Dental Inc | Dentist | 108 La Casa Via, Suite #102, Walnut Creek, CA 94598-3013 | 2016-11-14 |
| 1114370079 | Kwon & Jabbour Dental, Inc. | Clinic/Center | 108 La Casa Via, Suite 102, Walnut Creek, CA 94598-3013 | 2016-07-15 |
| 1619372380 | Mylife Recovery Centers, A Medical Corp. | Counselor | 108 La Casa Via, Suite 106, Walnut Creek, CA 94598-3013 | 2014-10-23 |
| 1093869455 | Unilab Corporation | Clinical Medical Laboratory | 108 La Casa Via, Ste 105, Walnut Creek, CA 94598-3013 | 2007-01-23 |
| 1851445944 | Qualium Corp. | Clinic/Center | 108 La Casa Via, Suite 100, Walnut Creek, CA 94598-3013 | 2007-01-23 |
| 1245336809 | Dennis Y. Fong, Professional Corporation | Family Medicine | 108 La Casa Via, Suite 104, Walnut Creek, CA 94598 | 2006-09-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639716608 | Tasnim Diaf Moulton | Counselor | 2730 Shadelands Drive, Walnut Creek, CA 94598 | 2019-12-09 |
| 1790255370 | Harmony Grace Davis | Behavior Technician | 2730 Shadelands Drive Bldg 10, Walnut Creek, CA 94598 | 2018-11-27 |
| 1922583772 | Melissa Anne Mcgovern | Behavioral Analyst | 2370 Shadelands Drive, Bldg 10, Walnut Creek, CA 94598 | 2018-09-27 |
| 1184108367 | Brett Heflin Woodrufff | Behavior Technician | 2730 Shandeland Dr. Building 10, Walnut Creek, CA 94598 | 2018-09-24 |
| 1710411640 | Mandy Wei | Pharmacist | 2880 Shadeland Dr, Suite 201, Walnut Creek, CA 94598 | 2017-04-18 |
| 1437683497 | Hayley Miller | Student in an Organized Health Care Education/Training Program | 2204 Lomond Lane, Walnut Creek, CA 94598 | 2017-04-17 |
| 1043601594 | Marlene Perez Riedel | Nurse Practitioner | 450 North Wiget Lane, Walnut Creek, CA 94598 | 2015-02-05 |
| 1922418904 | Dante Michael Sorrentino | Ophthalmology | Kaiser Permanente Park Shadelands Medical Offices, 320 Lennon Lane, Walnut Creek, CA 94598 | 2014-04-30 |
| 1194156505 | Robert Harrison Hubbell | Obstetrics & Gynecology | 838 Stonehaven Dr, Walnut Creek, CA 94598 | 2013-12-11 |
| 1174954192 | Paul Mead | Orthopaedic Surgery | 2405 Shadelands Dr Ste 300, Walnut Creek, CA 94598 | 2013-12-01 |
| Find all providers in zip 94598 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
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| Find all providers with the same taxonomy | ||||
| City | WALNUT CREEK |
| Zip Code | 94598 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.