1043507916 NPI number — RIVERSIDE RECOVERY RESOURCES

Table of content: (NPI 1043507916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043507916 NPI number — RIVERSIDE RECOVERY RESOURCES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVERSIDE RECOVERY RESOURCES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BETA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043507916
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 549
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE ELSINORE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92531-0549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-674-5354
Provider Business Mailing Address Fax Number:
951-674-5227

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3010 WEBSTER AVE
Provider Second Line Business Practice Location Address:
RIVERSIDE COUNTY PROBATION SCHOOL
Provider Business Practice Location Address City Name:
PERRIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92571-3168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-940-6061
Provider Business Practice Location Address Fax Number:
951-674-5227
Provider Enumeration Date:
06/29/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EASTERLING
Authorized Official First Name:
LOIS
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
951-674-5354

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)