Provider Demographics
NPI:1447469143
Name:RANCHO BRACING LLC
Entity type:Organization
Organization Name:RANCHO BRACING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-600-7400
Mailing Address - Street 1:26856 ADAMS AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6948
Mailing Address - Country:US
Mailing Address - Phone:951-600-7400
Mailing Address - Fax:951-600-7412
Practice Address - Street 1:26856 ADAMS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-6948
Practice Address - Country:US
Practice Address - Phone:951-600-7400
Practice Address - Fax:951-600-7412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5993690001Medicare NSC