1215202635 NPI number — RIVERSIDE RECOVERY RESOURCES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215202635 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 PROGRAM
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:
1215202635
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2012
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:
951-216-7300
Provider Business Mailing Address Fax Number:
951-216-7333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41125 WINCHESTER RD STE B2
Provider Second Line Business Practice Location Address:
RCOE CAL SAFE TEMECULA
Provider Business Practice Location Address City Name:
TEMECULA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92591-6045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-216-7300
Provider Business Practice Location Address Fax Number:
951-216-7333
Provider Enumeration Date:
03/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
TRUAX
Authorized Official First Name:
BERNARD
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CEO/BOARD CHAIRMAN
Authorized Official Telephone Number:
951-216-7300

Provider Taxonomy Codes

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

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





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