1811063050 NPI number — COUNTY OF RIVERSIDE

Table of content: (NPI 1811063050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811063050 NPI number — COUNTY OF RIVERSIDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF RIVERSIDE
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:
PALM SPRINGS WELLNESS AND RECOVERY CENTER
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:
1811063050
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3525 PRESLEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92507-4453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-782-2400
Provider Business Mailing Address Fax Number:
951-683-4904

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
191 N SUNRISE WAY STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92262-5201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-955-7058
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHANG
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, BEHAVIORAL HEALTH
Authorized Official Telephone Number:
951-358-4501

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 331612 . This is a "CADDS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 33AF , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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